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At least 343 records · Page 19Linked to original sources
PubMed1996

[Subarachnoid hemorrhage from the anterior communication artery in a sex offender. Considerations regarding liability].

A 32-year-old man was accused of attempted rape. While urinating at the side of the road he felt an erection. He approached a 9-year-old girl who happened to be coming along and pressed his penis between her legs until ejaculation. Shortly afterwards he was arrested. He confessed, but claimed partial amnesia and had no explanation for the offence, which he normally would never have thought of. Shortly before the event a witness had seen him nearby in a poor state of orientation. Three months later in prison he suffered massive subarachnoidal hemorrhage from an aneurysm of the anterior communicating artery. The evaluation of his legal responsibility must take account of a putative psychomotor seizure at the time of the offence. With regard to the aneurysm diagnosed later, a pathogenetic connection, in terms of a preceding warning leak, might be assumed.

Adult↗
PubMed2004

Anal fissures and anal scars in anal abuse--are they significant?

The notes of 214 children who, over a period of 7 years, had been referred after an allegation or a suspicion of any form of child abuse, were examined retrospectively to establish the pattern of injury found, especially with regard to anal fissures or scars. These were all children who had had their genitalia examined at the time of their referral. In 81 children (Group A) who had no history or evidence of sexual abuse, two fissures were found, both with medical explanations for their presence. In 83 (Group B) who alleged sexual abuse but denied anal abuse, nine (11%) had fissures or scars, and in four of the nine there was a history of significant constipation at some time. In 50 children (Group C) who had a strong history of anal abuse, 41 (84%) had fissures or scars. The diagnosis in 13 of these cases was considered definite because there was a confession or guilty plea from the abuser; in the remainder, the diagnosis was "not proven" despite a strong history or gross anal signs and regardless of the verdict in court proceedings. The significance of the findings was discussed with a view to clarifying the relative importance of anal fissures in children with a strong history of anal abuse.

Adolescent↗
PubMed2004

Three subsequent infanticides covered up as SIDS.

Within a period of 9 years a young woman lost 3 daughters during infancy and each time death was attributed to the sudden infant death syndrome. The children had different fathers and died at the ages of 11 weeks, 7 weeks and 2 weeks, respectively. A fourth daughter survived and lives separated from the mother together with her father and is healthy. At autopsy the last of the three deceased infants did not reveal any pre-existing pathological organ findings, except for acute pulmonary emphysema and extensive intra-alveolar bleeding. As a consequence the strong suspicion of mechanical suffocation arose. Subsequent police investigations produced incriminating clues that the first two children had also been suffocated. On confrontation with the autopsy findings and investigation results, the woman confessed that she herself had killed the first two infants by pressing a cushion on their faces. In the case of the third death the baby had been smothered by the child's father who in agreement with the mother put a plastic film on mouth and nostrils.

Adult↗
PubMed2006

Aconitine involvement in an unusual homicide case.

We describe a homicide complicated by an aconitine poisoning, which was initially thought to be a strangulation case. Routine toxicological analyses demonstrated only a small amount of alcohol in the blood and the urine. The case could not be clarified until 5 years after the event. A new element in the investigation made the wife the prime suspect, and finally, after thorough interrogation, she confessed her crime. She had mixed a decoction of three plants of Aconitum with red wine. Additional toxicological analyses, using the liquid chromatography-tandem mass spectrometry (LC-MS-MS) technique demonstrated 810 ng/ml of aconitine in urine, 6.5 ng/g in liver and 1.3 ng/g in the kidneys. Even though aconitine poisoning is still rare in Europe, it should be taken into account in suicides and homicides, particularly in unclarified cases.

Aconitine↗
PubMed1997

The diagnosis of a murder from skeletal remains: a case report.

A skeletonised body was found in a Danish forest. The examination of the bones revealed several incision on the skeleton, one located on the cervical column, two on the sternum, one perforating incision to the right iliac crest, and several superficial ones to the ribs and the right tibia. The skeletonized body was thought to be that of a young man in the twenties with a height of 170 cm. It was estimated that the body has been lying at the spot for at least 1 or 2 y and had been murdered by several stab wounds to the chest and abdomen. Police enquiries subsequently revealed that the deceased was a 23-year-old male with a height of 171 cm. A man confessed to having murdered the victim 1 1/2 years earlier with several stab wounds to the face/neck, chest, abdominal wall and thigh.

Adult↗
PubMed2000

Acute intoxication with aniline: detection of acetaminophen as aniline metabolite.

A 47-year-old woman unwittingly ingested an unknown substance together with her breakfast coffee. She suffered effects such as strong headache, generalized cyanosis, and a burning sensation of the lips and collapsed some minutes later. After admission into hospital a methemoglobin level of 35% was determined in the blood. Treatment by administration of tolonium chloride (toluidine blue) resulted in complete recovery of the patient. The toxic agent was identified as aniline by GC with mass selective detection after organic solvent extraction and 11 h after ingestion the plasma aniline level was 0.13 mg/l. Acetanilide (0.79 mg/ml) and acetaminophen (2.3 mg/ml) were identified in plasma as metabolites of aniline. It was assumed that a high metabolic capacity for acetylation protected the victim from more severe reactions. Her husband confessed later that he had tried to poison her.

Acetaminophen↗
PubMed2004

Munchausen syndrome by proxy with massive proteinuria and gastrointestinal hemorrhage.

A 5-year-old boy presented with acute abdominal pain. Massive proteinuria of 10 g/1.73 m(2) per day was detected on standard urinalysis. There was no peripheral edema. Serum concentrations of total proteins, lipids, and creatinine and immunological investigations were normal. Two kidney biopsies revealed no abnormalities. Several weeks later he was admitted for intestinal hemorrhage with significant anemia. Endoscopy of the esophagus, stomach, colon, and small bowel (via laparotomy) were normal. Electrophoresis of urine proteins revealed the unusual finding of an albumin fraction of 99.4%. During a routine check-up in the outpatient clinic fresh urine samples were obtained while the boy's mother was absent. These were all negative for protein. The mother, who was a nurse, finally confessed to adding human albumin to the urine samples.

Child, Preschool↗
PubMed1979

Spontaneous resumption of sinus rhythm in an elderly patient after 13 years of permanent atrial fibrillation.

One female patient--with slight pure mitral stenosis, mild hypertension and ischemic cardiomyopathy and disabling pulmonary emphysema--developed at 54 years of age permanent atrial fibrillation, had a gratuitous mitral commissurotomy four months later, sustained chronic fibrillation for 13 years, then spontaneously resumed sinus node command at age 67 without any discernible reason. Sinus rhythm was being maintained at follow-up nine months later. Her cardiac status of fair compensation under modest digitoxin and diuretic therapy has neither improved nor worsened with the return of atrial systole. The duration, in this observation, of permanent auricular fibrillation before spontaneous return of sinus rhythm, is one of the longest ever published, exceeded, to the best of my knowledge, only by one case of Lewis and by another one of Reeve and associates. Such an exceptional event points out a fascinating enigma: how can major longstanding atrial dysrhythmias (fibrillation, flutter), whose causes and pathogenesis seem at least partly elucidated, spontaneously disappeer in atria so badly diseased? I think we must humbly confess that no satisfactory explanation is at present available for this disconcerting phenomenon.

Adult↗
PubMed1993

Algorithmic and heuristic strategies in comprehension of complement clauses by patients with Parkinson's disease.

Language ability in patients with idiopathic Parkinson's disease (PD) and normal control subjects (NC) matched on age, sex, education and socioeconomic status (SES) was investigated. The two groups of subjects were tested on eight sentence types in Greek in the form of main and complement clause with eight matrix verbs. These matrix verbs were ask (ask information), promise (commissive meaning), tell1 (order, command) and tell2 (give information) in sentences with no semantic constraints, and confess, sell, trust and scold in sentences with semantic constraints (implicit causality). The results show that language ability, despite relative preservation is significantly impaired in PD patients as compared to that of NC. More specifically, syntax with semantic constraints was the most effective independent variable to classify PD patients and NC subjects into two distinct groups according to a Logistic Regression Analysis. To restrict the algorithmic process in sentence comprehension, PD patients seem to make use of the minimal distance principle (MDP) and the "experiencer constraint" heuristic strategies. Possible similarities in language behavior between PD patients and aphasics, in general, are suggested.

Aged↗
PubMed1983

The battered child: a study of the role of services in 25 cases of child abuse in The Netherlands.

With the help of a questionnaire and the study of 25 cases of child abuse from 1973 to 1976, the course of assistance given by various services and social workers involved was followed and the extent of the coordination between them was assessed. The starting point was the fact that when child abuse has reached the crisis stage many different bodies give immediate assistance to both the child and his parents. Later on, however, as help continues, it is not clear which of the persons or bodies concerned is really in charge of the case. The following conclusions were drawn: Abused children came from multiproblem families who often already have had contact with care or welfare services though no steps had been taken to intervene before ill-treatment was verified. Many parents confessed to ill-treatment of their child and desired help. Abused children were subjected to longer than usual hospital stays due to lack of reception facilities outside the hospital. Most ill-treated children abused enough to be hospitalized, were placed away from home although half of the parents did not agree with that decision. Of those later returned to their parents, over half had to be removed later for renewed ill-treatment and neglect. The need for one body to coordinate and be responsible for execution of plans for treatment was stressed.

Battered Child Syndrome↗
PubMed1988

The drum is the shaman, the spear guides his voice.

Kodi rituals of curing use anthropomorphized objects--the drum and the spear--as intermediaries to communicate with the spirits causing the affliction. The spear 'cuts through' to the cause of the illness at the divination, by guiding the arm and voice of the human diviner. The drum beaten during an all night ceremony has a more important role: a myth at the opening of the ceremony tells the drum's personal story or biography, which is identified with the suffering patient. In the course of the ceremony it travels on a shamanistic journey to the upperworld to seek the blessings of health and well-being. The myth of the drum's origin provides a narrative structure for the whole ritual, and defines the basis for its efficacy. The percussive sounds of the drum and gongs are said to make the patient feel better. A case study shows how 'ordered sound' is used to dissolve social tensions into a culturally structured pattern, so that consensus can be achieved in implicit accommodations in which neither party loses face. An older man's illness awakens guilty feelings among his younger relatives, whose thieving is believed to be responsible. The healing ritual creates the context for them to express contrition without confessing. Thus, although the rite re-establishes communication between persons and between the human and spirit worlds, it involves deception and silences as well as revelations. Through an analytic comment on social tensions, artistic illusions are used to overcome the airing of social differences. The healing rite is intended to restore a social consensus, produced by a combination of music, speech and actions, which allow signs to triumph over substance.

Ceremonial Behavior↗
PubMed2005

Symptom patterns in children and adolescents with obsessive-compulsive disorder (OCD).

OBJECTIVE: Obsessive-compulsive disorder (OCD) defined at the diagnostic level encompasses divergent symptoms. The present study examines symptom patterns in OCD in children and adolescents in order to search for the presence of diagnostic heterogeneity. SUBJECTS AND METHODS: Two hundred and thirteen outpatients with primary OCD participated. The patients' and primary caretakers' responses on the Children's Yale-Brown Obsessive-Compulsive Scale were used to generate severity ratings for 61 OCD symptoms, and cluster analysed them. RESULTS: A five cluster solution was judged to be the most clinically and theoretically relevant model. The clusters were named: (1) "Mental Rituals, Touching & Ordering", (2) "Contamination & Cleaning", (3) "Superstitions", (4) "Obsessions/Checking & Confessing" and (5) "Somatic Concerns". The symptom patterns of the groups differed, and three groups were particularly homogeneous. In addition, there were differences in severity, number of symptoms and age. CONCLUSIONS: OCD in children and adolescents is a heterogeneous disorder and discrepancies vis-à-vis adult studies indicate that childhood OCD may have developmentally specific traits. The sub-groups obtained are likely to have implications for the assessment of OCD symptoms in children, their prognosis and outcome in treatment research.

Adolescent↗
PubMed2005

Anabolic ergogenic substance users in fitness-sports: a distinct group supported by the health care system.

BACKGROUND: Anabolic ergogenic substance use, in particular the use of anabolic androgenic steroids, is a serious problem in general. Nevertheless, it is subject to debate whether ergogenic substance users exhibit similar features as multiple substance users or whether they constitute a discrete group. METHODS: One thousand eight hundred and two standardized, anonymous questionnaires were distributed among visitors of 113 fitness centers. Questions were asked concerning biometric parameters, social indicators, physical fitness, use of natural stimulants, general illicit drugs and ergogenic substances. With logistic regression analysis, multivariate odds ratios were estimated to investigate the association of anabolic ergogenic substance or general illicit drug use with other parameters. RESULTS: 13.5% of all participants confessed to having used anabolic ergogenic substances at some point in time. Anabolic ergogenic substance use was positively related with cocaine use, training years, training frequency, negatively related to the level of education, alcohol intake and less frequently used by Germans than by non-Germans. General illicit drug use, however, was positively related with alcohol intake, smoking and a university degree and negatively with having children. In addition, anabolic ergogenic substance use was significantly related with the use of general illicit drugs based on the strong relation with the use of cocaine, which is an ergogenic substance itself. The health care system supplies 48.1% of the anaolic ergogenic substance users with their substances and 32.1% are even monitored by a physician. CONCLUSIONS: The results of this study strengthen the notion that anabolic ergogenic substance users constitute a specific body-oriented substance user group. Uncommon for general illicit drug use, the health care system is a major sponsor of anabolic ergogenic substance users. These findings suggest the need for alternative approaches for successful prevention and intervention programs.

Adult↗
PubMed2007

An audit of surgical outcomes of esophageal squamous cell carcinoma.

OBJECTIVE: Esophageal squamous cell carcinoma and adenocarcinoma were increasingly recognized as two entities with different biologic behaviors and prognosis. Surgical risks and oncologic benefits of transthoracic and transhiatal esophagectomy for esophageal squamous cell carcinoma patients are not confessed. METHODS: Between 1994 and 2005, 216 esophageal squamous cell carcinoma patients underwent esophagectomy were enrolled and analyzed retrospectively. RESULTS: One hundred sixty-six patients underwent transthoracic esophagectomy and 50 patients underwent transhiatal esophagectomy. The overall hospital mortality and postoperative complication rates were 9.7 and 49%, respectively. The amount of intra-operative blood loss or transfusion, postoperative complication rate, lengths of hospital stay and hospital mortality rate were not significantly different between both groups. However, shorter operative time was noticed in transhiatal group (p<0.001). The overall 5-year survival rate was 16.8%. ESCC patients underwent either transthoracic or transhiatal esophagectomy had comparable long-term survival. The pTNM stage was independent prognostic factor for patients underwent transthoracic esophagectomy. However, location of tumor (p=0.009) and pathologic tumor length (p=0.012) were predictors of prognosis for patients underwent transhiatal esophagectomy. CONCLUSIONS: For esophageal squamous cell carcinoma patients, no significant differences in postoperative mortality or morbidity rates were observed between transthoracic and transhiatal esophagectomy. However, traditional pTNM staging system might underestimate the severity of esophageal squamous cell carcinoma patients who underwent transhiatal esophagectomy. The information of dissimilar prognostic factors for transhiatal or transthoracic esophagectomies will be helpful in tailoring more individualized adjuvant therapy to optimize esophageal squamous cell carcinoma patient's outcome.

Adult↗
PubMed2006

Darwin's young admirers.

In 1873, Darwin replied to the second letter from a young Dutch admirer, Nicolaas Doedes, in which he had eagerly asked about Darwin's religious views. Darwin stated that he could not believe that "this grand and wondrous universe" had only arisen by chance, but also showed his doubts about the existence of God. In 1881, Darwin repeated a similar agnostic view. After the death of Darwin in 1882, Doedes incurred the wrath of Francis Darwin by publishing the confession of his father in a Dutch freethinking journal, thus revealing the sensitivity of the information Darwin shared with Doedes.

Famous Persons↗
PubMed2004

The designer drug situation in Ibiza.

A total of 137 urine samples and 46 serum samples, corresponding to 154 self-confessed designer drugs consumers in Ibiza island, were analyzed for the presence of designer drugs: amphetamine and amphetamine derivatives (methamphetamine, methylenedioxymethamphetamine (MDMA), methylenedioxyethylamphetamine (MDEA), methylenedioxyamphetamine (MDA), p-methoxymethylamphetamine (PMMA), p-methoxyamphetamine (PMA), etc.), ketamine and gamma-hydroxybutyric acid. Among this population, coming both from the forensic clinic and from the emergency room of a hospital, a total of 99 cases were found positive for some designer drug. This study shows the prevalence of methylenedioxymethamphetamine (MDMA) among designer drug users, sole or in association with other drugs. Also, the mixture of MDMA with other designer drugs, ethanol and/or cocaine is shown to be more likely to produce toxic symptoms requiring clinical attendance in a hospital emergency room. These findings along with the consumption history, the concentrations of drugs and metabolites in urine and serum and the toxicological significance for the interpretation of some MDMA metabolites such as 4-hydroxy-3-methoxymethamphetamine (HMMA) are discussed in this study.

Designer Drugs↗
PubMed2005

Subgaleal hematoma in child abuse.

The mother brought her 31/2-year-old son to a paediatric clinic as his forehead was swollen and bluish in appearance. She was unable to give any explanation for this lesion. Clinically it was noted that a very visible and also palpable, doughy swelling was present both in the forehead as well as the hard skull areas. Some hours later, a massive bilateral periocular haematoma appeared. Whilst X-rays were unable to provide any diagnostic help, the sonographic examination of the skull carried out on the same day revealed an extensive subgaleal haematoma. This phenomenon is described in radiological literature as "scalping" and is caused by the use of considerable, blunt violence against the head (shear stresses, e.g. by pulling at the hair). The mother's boyfriend later confessed forceful pulling of the hair.

Child Abuse↗
PubMed2007

A comparison of pulmonary intra-alveolar hemorrhage in cases of sudden infant death due to SIDS in a safe sleep environment or to suffocation.

The differentiation of SIDS from accidental or inflicted suffocation may be impossible without corroborating findings from the death scene or autopsy or in the absence of a confession from a perpetrator. Pulmonary intra-alveolar hemorrhage (PH) has been proposed as a potential clue to suffocation, but none of the previous studies on this topic have limited SIDS cases to those who were in a safe sleep environment, in which all were found supine and alone on a firm surface with their heads uncovered. Our aims are to: (1) compare PH in SIDS cases found in a safe sleep environment to a control group comprised of infants whose deaths were attributed to accidental or inflicted suffocation and (2) assess the effect of age, CPR, and postmortem interval (PMI), with regard to the severity of PH in this subset of safe-sleeping SIDS cases. We conducted a retrospective study of all postneonatal cases accessioned by the Office of the Medical Examiner in San Diego County, California who died of SIDS or suffocation between 1999 and 2004. A total of 74 cases of sudden infant death caused by SIDS (34 cases as defined above, comprising 8% of the total SIDS cases), accidental suffocation (37), and inflicted suffocation (3) from the San Diego SIDS/SUDC Research Project database were compared using a semiquantitative measure of pulmonary intra-alveolar hemorrhage. The most severe (grade 3 or 4) PH occurred in 35% of deaths attributed to suffocation, but in only 9% of the SIDS cases. Age, duration of CPR attempts and PMI had no effect on the severity of PH in SIDS. Our results indicate that the severity of PH cannot be used independently to differentiate SIDS from suffocation deaths. Each case must be evaluated on its own merits after thorough review of the medical history, circumstances of death, and postmortem findings.

Asphyxia↗