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PubMed1994

Development of a clinical forensic medicine curriculum for emergency physicians in the USA.

To address the forensic needs of living patients, the Department of Emergency Medicine at the University of Louisville School of Medicine in Louisville, Kentucky, USA initiated the first clinical forensic medicine training programme in the USA. In July 1991, formal training in clinical forensic medicine was incorporated into the core curriculum of the USA's second oldest academic emergency medicine training programme. The University of Louisville, in cooperation with the Kentucky Medical Examiner's Office, developed the curriculum to provide the emergency physician with the knowledge base and technical skills to perform forensic evaluations of living patients. Forensic lectures are given monthly by local and regional forensic experts including: forensic pathologists, prosecuting attorneys, firearm and ballistics examiners, law enforcement officers, forensic chemists and forensic odontologists. Topics which are presented include: forensic pathology, forensic photography, ballistics and firearms analysis, paediatric physical and sexual assault, crime scene investigation, forensic odontology, courtroom and expert testimony and the forensic evaluation of penetrating trauma. As a result of the introduction of clinical forensic medicine into the core curriculum of an emergency medicine training programme the residents are now actively addressing the forensic issues encountered in the Emergency department. Key, often short-lived forensic evidence, which was frequently overlooked or discarded while delivering patient care is now recognized, documented and preserved. The development and introduction of a clinical forensic medicine curriculum into emergency medicine training has greatly enhanced the emergency physician's ability to recognize, document and address the forensic needs of their patients who are victims of violent and non-fatal trauma.

Journal Article↗
PubMed2006

Major incident response: collecting ante-mortem data.

The Asian tsunami of 26 December 2004, which devastated coastal parts of more than 10 countries in and around the Indian Ocean caused over 200,000 casualties. People from more than 58 nationalities were amongst the victims and subsequently an international effort for disaster victim identification (DVI) was set up, coordinated by Interpol. DVI teams from more than 20 countries took part in the identification process which, because of the complexity of the situation, had to be conducted in an internationally agreed upon procedure. Standard operating protocols of post-mortem (PM) procedures were established for fingerprinting, forensic pathology, forensic odontology and DNA profiling and were crucial in the quality of the entire DVI process of the quickly decomposing bodies. A very important and underestimated part of the DVI process is the gathering of the ante-mortem (AM) data of the persons reported missing in their home countries. In the wake of this tsunami event it appeared to be even more problematic as entire families had died and information was difficult to obtain. As dentistry proved to be the most valuable identification mean--up to 85% of the cases--the AM dental records proved to be crucial elements for DVI. Standard operating protocols (SOP) were again established as to who, where, when and what information had to be collected by the dentists by the AM teams abroad. Transcribing the AM dental information by experienced forensic odontologists was another crucial element in the whole identification procedure as the information had to be loaded into the DVI System International (Plass Data, Holbaek, Denmark) for comparison with incoming PM data. The Interpol DVI Standing Committee thus recommends that forward planning, adequate funding, international cooperation and standardisation are essential to guarantee an effective response to any major mass disaster of this kind in the future.

Asia, Southeastern↗
PubMed1999

Surfing the web or drowning in data: a subjective analysis of site and information availability on forensic-related subjects on the internet.

A subjective analysis of information available on the Internet to those working in forensic medicine medicine was performed. Internet web sites addressing forensic pathology, forensic science, anthropology, entomology, law enforcement, societies and journals were assessed. Ease of access, presentation, structure, specialization, links and popularity were reviewed. Each individual site assessed was graded out of 100 and ranked, by subject, to provide the reader with a generalized guide to what the authors considered was useful and/or interesting forensic sites on the internet. The need for a regulatory body for forensic Internet resources is discussed.

Journal Article↗
PubMed2005

After the Indian Ocean tsunami: Singapore's contribution to the international disaster victim identification effort in Thailand.

This paper describes the international disaster victim identification (DVI) response mounted in Thailand, with particular reference to Singapore's contribution to this process, in the wake of the Asian tsunami of 26 December, 2004, which devastated parts of more than 10 countries in and around the Indian Ocean and claimed more than 200,000 lives. Although Singapore was unscathed by this natural calamity, over 30 Singaporean visitors were counted amongst the thousands of deceased victims, mostly in Thailand. The systematic application of forensic pathology, forensic dentistry, DNA profiling, and fingerprinting to human identification, especially of the bodies of various nationalities that were in advanced states of putrefaction, was crucial to the entire DVI process. The authors perceive that the resource implications arising from such a disaster, which is unprecedented in both its scale and reach in the international history of DVI, are immense. Forward planning, adequate funding and international cooperation are essential to mounting an effective response to any major mass disaster of the future.

Bayes Theorem↗
PubMed2003

[Place of pathology in the forensic diagnosis of drowning].

The diagnosis of drowning is one of the most difficult in forensic pathology. Drowning is death through the aspiration of fluid into the air passages. Signs of immersion only demonstrate submersion of the body for a period of time but are not signs of drowning. The best signs of drowning are froth around the mouth and nostrils and lung distension. Lung histology in drowning victims shows non-specific lesions such as "emphysema aquosum" and alveolar edema. The diatom test for drowning requires a careful protocol to avoid possible contamination. Sample collection (cardiac blood, lung, liver, kidney tissue, bone marrow and brain) should be performed during the first part of the autopsy. Sample preparation requires chemical or enzymatic digestion. The diatom test should be both qualitative and quantitative. Species recovered from the body must correspond to those from the site of drowning and approximately in the same proportions. The diatom test has poor sensitivity and thus is much debated because it is always difficult to rule out possible contamination. Moreover, a negative diatom test cannot rule out drowning as the cause of death. The diagnosis of drowning is based on police investigations, forensic autopsy, microscopic analysis, and biochemical tests, but never solely on pathology findings.

Autopsy↗
PubMed2003

Mitochondrial mutagenesis in the brain in forensic and pathological research.

Accumulation of alterations to the mitochondrial DNA (mtDNA) would be expected to significantly impair the bioenergetic function of mitochondria in the affected host cells. Many of these changes have been associated with several specific diseases and the process of aging. These mutations may be the result of mitochondrial oxidative stress, which is increased with age of individuals and specific degenerative diseases. Our aim with this review is to summarize the recent literature on the occurrence of mtDNA alterations and its possible relation to age-depending degenerative processes with special regards to the brain. Additionally, we show how these alterations could be used in fields of pathology and forensic medicine.

Age Factors↗
PubMed2006

Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 2: analysis for application in the diagnosis of sudden cardiac death with regard to pathology.

Although previous forensic pathological studies have suggested the possible application of cardiac troponins in the diagnosis of myocardial infarction, there appears to be insufficient data with regard to its cardiac pathology. The present study analyzed the heart blood, peripheral blood and pericardial fluid levels of cardiac troponin T (cTnT) in sudden cardiac deaths (n = 96) within 48h postmortem in relation to pathological findings of acute myocardial infarction (AMI, n = 34), recurrent myocardial infarction (RMI, n = 23), ischemic heart disease without any pathological evidence of infarction (IHD, n = 24) and other heart diseases (OHD, n = 15). Control groups (n = 75, survival time <24 h) within 48 h postmortem consisted of asphyxiation (n = 35), drowning (n = 27) and cerebrovascular diseases (n = 13). There was a marked correlation in the cTnT levels between right and left heart blood samples. The pericardial level was usually higher than either heart blood level, and the external iliac venous blood level was the lowest. Although postmortem time-dependent increases in heart and pericardial blood cTnT levels were observed in most groups, they were most evident for AMI and asphyxiation. In the early postmortem period (<12 h) there was no significant difference between AMI or RMI and the other groups except for drowning. After 12 h postmortem, significantly elevated heart blood and pericardial cTnT levels were observed for AMI and RMI showing multiple interstitial hemorrhages and necrosis compared to those with localized eosinophilic changes or patchy interstitial hemorrhages, IHD and OHD. These differences were the smallest for peripheral blood. For sudden cardiac death cases, the difference in cTnT level at each site among the causes of death was independent of gender, age, heart or lung weight and pathologies of affected coronary artery and severity of coronary stenosis. These observations suggest that the elevation in postmortem blood and pericardial cTnT levels in sudden cardiac death may depend on the severity of ischemic myocardial damage including the size and intensity of myocardial lesions involving multiple interstitial hemorrhages and necrosis, and also the postmortem period for heart and pericardial levels.

Adolescent↗
PubMed2004

Forensic medicine in Tunisia.

Tunisia is an Arab northern African country which counts 10 millions citizens. In Tunisia, there is a small number of forensic practitioners (20) distributed over four University and two regional Hospitals. Forensic activity is under the supervision of Tunisian Ministry of Public Health. The first forensic medicine department was set up in the Faculty of Medicine of Tunis (the capital) in the sixties, after which three other departments were founded in medical faculties and in their respective university hospitals (Sfax, Sousse and Monastir). These departments provide forensic medical education and research beside their daily practice. Forensic medical practice is divided in forensic pathology and clinical forensic medicine. In forensic pathology, we have to deal with violent or suspected deaths beside natural deaths. The clinical forensic medicine activity covers mainly forensic traumatology. Other fields of forensic sciences are in progress and ought to be developed all over the country. A forensic medical curriculum is provided in the four Tunisian Faculties of Medicine and in their University Hospitals. Nevertheless, the number of trainees remains small and could not currently satisfy the country needs.

Forensic Medicine↗
PubMed2001

Founding editorial--forensics and TheScientificWorld.

At the beginning of a new millennium it seems a good idea to stop for a moment and take stock of the current state of forensic science. As a field of scientific research and scientific application, forensic science is a little more than a century old. Forensic science may be said to have begun in 1887 with the simultaneous publication of A. Conan Doyle's A Study in Scarlet and Hans Gross's Handbuch f1/4r Untersuchungsrichter. Conan Doyle's novel introduced to the world the character of Sherlock Holmes, whose literary career would popularize the use of physical evidence in criminal investigations. Gross's manual for examining magistrates suggests ways in which the expertise of chemists, biologists, geologists, and other natural scientists could contribute to investigations. Gross's book was translated into a number of languages and went through various updated editions during the course of the century. The intervening century saw the development and application of fingerprinting, firearm and tool mark identification, forensic chemistry, forensic biology, forensic toxicology, forensic odontology, forensic pathology, and forensic engineering. Increasingly, the judicial systems of the industrial nations of the world have come to rely upon the expertise of scientists in a variety of disciplines. In most advanced countries, virtually all criminal prosecutions now involve the presentation of scientific testimony. This has had the beneficial effect of diminishing the reliance of courts on eyewitness testimony and defendant confessions.

DNA↗
PubMed2006

Size and location of the fetal human ovary.

OBJECTIVE: To determine the development and the localization of the ovaries during the fetal period. MATERIAL AND METHODS: One hundred and fifty-four ovaries obtained from 77 human fetuses aged between 9 and 40 weeks of gestation were used in this study. Firstly, the shapes and the positions of the ovaries were established. Second, the localization of the ovaries with respect to linea terminalis, ureters, and the iliac arteries were determined. Finally, the dimensions and the weight of the ovaries were measured. FINDINGS: In the fetal period, the ovaries were most commonly almond shaped and had an oblique orientation. In the 1st trimester the midpoint of the long axis of the fetal ovaries were at the level of linea terminalis. In the 2nd and 3rd trimester and full-term fetuses, it was observed that the ovaries were not in ovarian fossa, suggesting that descensus ovary was in progression during these times. During the intrauterine period, the ovaries were most commonly located anterior to the ureters and over the common iliac artery, only to migrate to its final location between the internal and external iliac arteries towards the end of the 40th week. CONCLUSION: We found that the ovaries did not assume the position of the adults at the end of the fetal period, rather continued its descent after the birth. We believe our findings about the fetal ovaries will be useful in obstetrics, fetal pathology, and forensic pathology.

Female↗
PubMed1975

[Responsibility of technicians in departments of pathology and forensic medicine].

Several cases have been presented to demonstrate that the technicians' work in Departments of Pathology and Forensic Medicine is rather pretentious and responsible. Technicians must always bear in mind that any neglection may have severe consequences, social as well as medical and legal. Therefore technicians are expected to do their work meticulously, being aware of their responsibility. They should not obscure their errors. In only such cases the technician will adequately meet the requirements of our health care.

Adult↗
PubMed2005

Forensic medicine services in Uganda--present and future.

Forensic medicine services (medico-legal services) as it is provided today in Uganda is discussed with special reference to forensic pathology and also to future plans for improvement to ensure quality service. Forensic medicine services are divided into clinical forensic medicine and forensic pathology. In Uganda, these services are rendered partly by pathologists attached to University, by pathologists and medical officers employed by police and by medical officers attached to hospitals. In Uganda, all types of unnatural deaths are reported to nearest police station and appointed investigating police officer(s) will take necessary action to have a medico-legal postmortem done as soon as possible. Currently there is no qualified forensic pathologist in Uganda. Suggestions are made with regard to the enactment of a Forensic Medicine Services Act by the Department of Health, the creation of a forensic medicine unit with, under the administrative umbrella of pathology department, in medical schools and imparting of forensic medicine training to anatomical pathologists to act as a qualified, specialist forensic pathologists.

Autopsy↗
PubMed1992

The development of forensic medicine in the United Kingdom from the 18th century.

Forensic medicine in the United Kingdom includes both forensic pathology and clinical forensic medicine on the living. It began at the end of the 18th century, long after its development in Germany, Italy, France, and other countries in Europe. Initial beginnings were in Scotland, where a program began at the University of Edinburgh with the establishment of a chair in Forensic Medicine by Prof. Andrew Duncan Sr. The development in England began in London's Kings College Medical School with a chair held by Prof. William A. Guy. Later chairs in Forensic Medicine were established in Glasgow, Aberdeen, and in London, where Forensic Medicine was taught at St. Mary's Hospital Medical School, Guy's Hospital Medical School, London Hospital Medical School, Charing Cross Hospital Medical School, St. Thomas Hospital Medical School, and St. George's Hospital Medical School. In other cities in England, Wales, and Northern Ireland, departments were founded in Leeds, Manchester, Cardiff, and Belfast. Many textbooks were prepared during this time by professors from these medical schools and by others working in nonacademic areas. The development of coroner activities and those of the police surgeons is also part of the study of forensic medicine.

Forensic Medicine↗
PubMed2000

Medical examination of sexually abused children: medico-legal value.

UNLABELLED: The Department of Forensic Medicine (forensic pathology and clinical forensic medicine), Aarhus, Jutland, Denmark, performs examinations of children suspected to have been sexually abused when reported to and requested by the police in Jutland, Denmark. Jutland covers an area of 210,000 km2 with about 300,000 inhabitants in Aarhus. A colposcope initially equipped with an Olympus camera, but now with a video camera attached has been used since 1994. Since 1994 the department has performed more than 100 examinations of children suspected of having been sexually abused. A preliminary study was taken to evaluate all cases from 1995 including the legal outcome. RESULTS: The material included 34 cases with three boys, mean age 11 years, and 31 girls, mean age 8 years, at the time of the examination. The sexual abuse events were fondling including penetration of the vagina, vaginal (14), anal (7), and oral (5) intercourse as well as cunnilingus and nontouching abuses. The medical examination was most often performed more than a week after the abuse. The examination revealed normal findings in 23 cases, nonspecific findings including erytherma in 13 cases, and in only one child was a traumatic lesion with rupture of the hymen seen. The perpetrators were above 25 years of ane and were family members or someone known to the child. Nine perpetrators were convicted at court, of whom three admitted having abused the child. CONCLUSION: A medical examination in cases of sexual child abuse seldom provides a legal proof of sexual abuse. The most important is the story told by the child. Therefore, the examination is a supplement which may support or remain neutral to the story told by the child.

Abdominal Pain↗
PubMed1996

Pathological gambling: forensic issues.

OBJECTIVE: The aim of this paper is to review the literature describing the hypothesised link between crime and pathological gambling and its relevance to arguments of diminished responsibility. METHOD: An attempt was made to include all publications in the psychiatry and psychology literature which made reference to pathological gambling and criminal behaviours. Given the limited research in this field, specific unpublished conference papers were also included in the review. RESULTS: Evidence supports the contention that pathological gamblers are at high risk for committing criminal offences in order to maintain their habitual gambling behaviours. An antisocial personality disorder while acting to increase the risk factor is in itself an insufficient explanation for the observed link. As a result of the acceptance of pathological gambling as a psychiatric disorder, the judicial system is being increasingly confronted with an argument of diminished responsibility for gambling-related offences committed by pathological gamblers. CONCLUSION: A diagnosis of pathological gambling does not diminish legal responsibility but is a factor that should be considered in sentencing. Referral to psychiatric services reduces the risk of recidivism.

Adolescent↗