Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CONFESSION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources
PubMed2004

Normal computerized tomography of brain in children with shaken baby syndrome.

OBJECTIVE: To characterize the clinical presentation and clinical course of shaken baby syndrome (SBS) with normal cranial computerized tomography (CT) on admission and to suggest further diagnostic procedures in such circumstances. METHODS: Using a worldwide listserv designed to facilitate discussion in the field of child abuse and neglect, we solicited case information for children hospitalized in different medical centers, who were diagnosed with SBS and had a normal CT scan on admission. RESULTS: Nine cases were identified. While all children had an abnormal neurologic examination on admission, eight had a normal CT, and one had "widening of cranial sutures." In four cases, subdural hemorrhage was diagnosed on magnetic resonance imaging (MRI) 3 to 7 days after admission. Five children had bone fractures. The neurological outcome was normal in four of nine cases. Five children had long-term neurologic damage. The diagnosis of SBS was supported by either perpetrator confession, characteristic evolution of brain abnormalities on CT or MRI, inconsistent or absent explanatory history, and/or other social risk factors. CONCLUSION: The diagnosis of SBS can be established even when brain CT is normal on admission. The documentation of retinal hemorrhages is of primary importance in establishing the diagnosis of SBS in these cases.

Brain↗
PubMed2004

The end of life decisions -- should physicians aid their patients in dying?

Decisions pertaining to end of life whether legalized or otherwise, are made in many parts of the world but not reported on account of legal implications. The highly charged debate over voluntary euthanasia and physician assisted suicide was brought into the public arena again when two British doctors confessed to giving lethal doses of drugs to hasten the death of terminally ill patients. Lack of awareness regarding the distinction between different procedures on account of legal status granted to them in some countries is the other area of concern. Some equate withdrawal of life support measures to physician assisted suicide whereas physician assisted suicide is often misinterpreted as euthanasia. Debate among the medical practitioners, law makers and the public taking into consideration the cultural, social and religious ethos will lead to increased awareness, more safeguards and improvement of medical decisions concerning the end of life. International Human Rights Law can provide a consensual basis for such a debate on euthanasia.

Attitude to Death↗
PubMed2006

Postmortem sole incisions - a new sign of heroin overdose?

Postmortem sole incisions have been observed in a number of heroin overdose fatalities. Acqueintance of those victims confessed to producing those incisions as a life saving procedure in a futile attempt to help the comatose overdose victim. They thought that bleeding the unconscious victim would remove the overdose, in manner similar to bloodletting or phlebotomy which is still popular in the Gulf region. The presence of such wounds has become a first indication or rather "sign" of heroin poisoning. In such cases, laboratory investigation confirmed the pathologist's preliminary suspicion. In Dubai, postmortem sole incisions are important sign of death from heroin overdose even in the absence of other classical signs. This sign becomes more credible when accompanied by other signs and/or circumstantial evidence suggestive of heroin use. It is suggested that this should be called "bloodletting sign" of death from heroin overdose. The sign should not be confused with the self-inflicted cuts seen on the arms and forearms of drug misusers which are caused for other reasons.

Adolescent↗
PubMed2006

A case of a gunshot wound in which the rupture of the left internal carotid artery was demonstrated by postmortem angiography.

A 54-year-old man was shot into the face by a robber while sleeping in bed. Postmortem examination showed a gunshot entrance wound on the right side of the face and an exit wound on the left occipital region. Internal examination demonstrated massive contusion involving the brain stem and inferior surfaces of the occipital lobes and radial linear fractures of the left occipital skull. Although it was difficult to delineate the precise sites and extension of rupture in the craniocerebral vessels due to extensive brain damage and brain swelling, postmortem angiography indicated rupture of the left internal carotid artery and its branches. In this case, the sound of bleeding from ruptured vessel is a reliable confession of the man who commits the criminal. Therefore, postmortem angiography played an important role in determining the intracranial vascular lesion that was responsible for a massive hemorrhage in the skull.

Angiography↗
PubMed2005

Could obsessive-compulsive disorder have originated as a group-selected adaptive trait in traditional societies?

Obsessive-compulsive disorder (OCD) possesses distinctive characteristics inviting evolutionary and anthropological explanations. A genetically based condition with low fecundity persisting through generations is paradoxical. The concept of group selection is an evolutionary principle capable of clarifying the perplexing epidemiology of OCD. Using a group-selection paradigm, the authors propose that OCD reflects an ancient form of behavioural specialization. The majority of compulsions such as checking, washing, counting, needing to confess, hoarding and requiring precision, all carry the potential to benefit society. Focussing primarily on hunting and gathering cultures, the potential evolutionary advantages of OCD are explored.

Adaptation, Biological↗
PubMed1990

Suffocation, recurrent apnea, and sudden infant death.

We reviewed the cases of 27 young children from 27 different families who were suffocated by their mothers. The certainty, or near certainty, of suffocation was based on reliable observation or recording of the suffocation, maternal confession, or successful prosecution in a criminal court. Eighteen of the children are alive, although one has severe brain damage; nine are dead. Twenty-four were reported to have had previous episodes of apnea, cyanosis, or seizure, and 11 had had 10 or more such episodes that were either invented or caused by the mother. Repetitive suffocation usually began between the ages of 1 and 3 months and continued until it was discovered, or the child died, 6 to 12 months later. The 27 children had 15 live elder siblings and 18 who had died suddenly and unexpectedly in early life; 13 of the dead siblings had had recurrent apnea, cyanosis, or seizures, and, although most of them at the time of death were certified as having sudden infant death syndrome, it is probable that some were suffocated. Repetitive suffocation has a characteristic clinical presentation that should allow identification before brain damage or death occurs. The characteristics should also allow the cause of death of some cases of sudden infant death to be established more accurately.

Adult↗
PubMed1987

Cytochemistry of the gas-exchange area in vertebrate lungs.

Considerable progress has been made in the localization of chemical substances within the gas-exchange zones of vertebrate lungs since cytochemical techniques suitable for use with the electron microscope have been developed. The light microscope, an instrument with an effective resolution limit of about 0.2 micron, is ill-suited for studying regions such as these where small tissue elements are arranged in a complex manner. A wide range of acid hydrolases have been detected in the vacuoles and dense bodies of alveolar macrophages by means of cytochemical techniques. The enzymes demonstrated in this way include acid phosphatase, aryl sulphatase, cathepsin D, beta-glucuronidase, acetyl glucosaminidase, nonspecific esterase, dipeptidyl peptidase II and dipeptidyl peptidase IV. Such enzymes are, of course, to be expected in the lysosomes of cells which have a primary phagocytic role. Nevertheless, it must be confessed that very little is yet known about the actual mechanism of phagocytosis or of the fate of the digested material. It is fortunate, however, that some of the tools which are likely to be of value in research on these aspects of macrophage function are currently being developed. Of particular interest in this connection are the immunocytochemical techniques which permit the localization of surface-associated antigens and intracellular contractile proteins. It must be emphasized that phagocytosis is not the only function of macrophages in the gas-exchange zone of the lung. These cells are thought to be involved in the presentation of exogenous antigenic material to the reactive cells of the lymphoid system. Recent research has also indicated that mammalian alveolar macrophages synthesize a diverse range of substances. Furthermore, the elastases associated with pulmonary macrophages are now thought to be involved in the pathogenesis of emphysema. All of the above-mentioned activities are of great biological and clinical significance and, consequently, merit the cytochemists' attention in future. The epithelial lining of the greater part of the pulmonary gas-exchange area is composed of type I pneumonocytes. In terms of ultrastructure, these are very specialized cells; their extensive and highly-attenuated cytoplasmic processes form the outer layer of the air-blood barrier. No special carrier systems have been identified within type I pneumonocytes and this is in keeping with the claims that oxygen is transferred across the alveolar tissue barrier by a process of simple diffusion. Type II pneumonocytes, in contrast, have considerable metabolic activity.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2001

The torturous road to democracy--domestic crisis in Nepal.

Largely unnoticed by the outside world, an armed Maoist insurgence has wrested control of areas in 45 of Nepal's 75 administrative regions and has resulted in more than 1700 deaths since 1996.(1) State figures indicate that 1000 of these people were Maoist and about 400 were police-120 of whom died in attacks on police outposts in early April and July of 2001 alone. The remainder were "class enemies" of the "People's War"-ie, members of ruling parties. As public security collapses, the consequences for the Nepalese are random imprisonment, torture, and risk of extrajudiciary execution from both sides. Torture has increased greatly as a consequence of the insurgence, but was already deeply rooted in Nepalese authority and used as a primary approach to solving crime. More than 70% of Nepalese prisoners claim to have been tortured while in custody, and at least 50% claim they signed confessions as a result. INSEC (Informal Sector Service Centre), a human rights organisation, documented 1035 cases of state perpetrated torture in the year 2000,(2) which has been suggested to be a gross underestimate of the true figure. The long-term physical, social, and psychosocial consequences for survivors are often severe. The Centre for Victims of Torture, Nepal, a non-government organisation based in Kathmandu, has been studying the effect of torture on survivors, and has implemented Nepal's only treatment programmes for those brave enough to seek help.

Humans↗
PubMed1993

Atypical ocular atopy.

BACKGROUND: Atopic keratoconjunctivitis (AKC) is defined as a chronic keratoconjunctivitis associated with atopic dermatitis, but severe progressive keratoconjunctivitis as a sole manifestation of atopy also may occur. The authors report three patients with a longstanding history of chronic conjunctivitis with bilateral pannus formation. These patients denied any history of major atopy at the time of presentation. METHODS: All patients were evaluated for collagen vascular disease and for evidence of atopy. Conjunctival biopsy was obtained in each case and was analyzed by light microscopy and by immunohistochemical techniques. RESULTS: Systemic evaluation for collagen vascular disease was negative. Serum IgE levels were elevated in one patient. Conjunctival biopsy suggested atopy in all patients with characteristic histopathologic findings. Referral to an allergist showed wheal and flare reactions to multiple ubiquitous environmental allergens. Two patients then disclosed a history of atopic dermatitis and another confessed a history of asthma. Each patient responded well to environmental control of allergens, topical cromolyn sodium 4%, and systemic antihistamine therapy with subsequent resolution of the chronic conjunctivitis. The corneal complications were managed with pannus resection and postoperative mitomycin C drops in two patients. CONCLUSION: These patients suffered from the progressive blinding consequences of a chronic keratoconjunctivitis, which we believe is an atypical form of AKC. In this report, it is suggested that atopy should be considered in some cases of external ocular inflammation, even in the absence of the characteristic findings of systemic atopy. Conjunctival biopsy is a valuable diagnostic tool in such cases.

Adult↗
PubMed1997

Persistent cerebrospinal fluid otorrhea: a case of Munchausen's syndrome by proxy.

A case is presented of a young child who initially presented with recurrent bacterial meningitis 1 year after significant head trauma and was found to have cerebrospinal fluid (CSF) leakage into the middle ear. Surgical procedures were devised to attempt to stop this abnormal flow, but inexplicably clear otorrhea biochemically identical to CSF persisted for weeks. The child's mother was apparently soaking the surgical dressings with CSF obtained through a lumbar drain and confessed to this activity after she was found to have tampered with an intravenous catheter. This activity resulted in a prolonged hospital stay and several presumably unnecessary procedures. Munchausen's syndrome, typified by intentional mimicry of symptoms of serious illness backed by plausible medical history, is well-described. Rarer is the syndrome by proxy, where parents and/or caregivers, by falsifying histories, fabricating laboratory evidence, or deliberately generating bodily lesions, cause unneeded diagnostic and therapeutic procedures to be performed on their young victims. This form of child abuse is hidden by the perpetrator's apparent concern and involvement in the care of the victim. The literature is reviewed, this form of abuse is discussed, and the role of communication of suspicion between the various health care workers is stressed. The medical and social settings in which this disorder is prevalent are covered. Early detection of this entity is essential in rescuing the victim from life-threatening abuse and in obtaining appropriate therapy for the abuser.

Cerebrospinal Fluid Otorrhea↗
PubMed1999

Role of bronchoscopy in asthma research.

Over the past 15 years, much has been learned about the presence of airway inflammation in asthma through the use of investigative bronchoscopy. It has become quite clear that inflammation is present even in mild asthma. In addition to the eosinophils, T-lymphocytes and a variety of cytokines have been identified to play a prominent role in asthmatic inflammation. The concept of delayed asthmatic response after allergen exposure and its relationship to cellular inflammation and airway hyper-reactivity has become more clearly established. Our understanding of asthmatic airway inflammation, however, is incomplete. As interesting as the database has been so far, investigative FB has not defined a unique profile for patients with asthma. Specifically, lavage or endobronchial biopsy has not identified parameters that help in the diagnosis, assessment of disease severity, prognosis, or likelihood to respond to specific therapies. Also, the exact relationship between parameters in lavage compared with mucosal biopsy and how these are related to airway hyper-reactivity and the clinical syndrome of asthma remains poorly understood. In this regard, it must be confessed that currently FB with lavage and biopsy in asthmatics needs to be considered as a research tool for specimen retrieval to help characterize and express inflammation. Although these techniques have contributed immensely to our understanding of asthma pathogenesis, presently these techniques do not have any practical role or clinical usefulness.

Asthma↗
PubMed2001

DYS STR analysis with epithelial cells in a rape case.

We report here the application of Y-chromosomal DNA analysis in a rape case, which occurred in Stuttgart, Germany. Microscopic examination of the victim's vaginal swabs and her underwear showed no sperm cells. DNA was extracted from vaginal and epithelial cells and analysed with the autosomal systems SE33, THO1 (singleplex) and with the multiplex Profiler Plus (Applied Biosystems, Foster City, USA). The results of these autosomal STR analysis gave no hint at a mixed sample and failed to identify a male profile. DYS STR analysis with the systems DYS391, DYS392, DYS393, DYS19 and DYS389 I/II showed the same characteristic features as the suspect. We used this incomplete haplotype to search in the Y-STR Haplotype Reference Database via Internet. In a Caucasian population sample of 3589 minimal haplotypes we found 71 matches. The suspect confessed the crime and was finally condemned to 4 years imprisonment.

DNA↗
PubMed2001

Kicking to death - forensic and criminological aspects.

A total of 36,274 forensic autopsies was performed in Berlin, between 1980 and 1987, including 152 cases (0.42%) in which death had been caused by blunt violence due to kicking. Data were collected on both victims and offenders, postmortem findings, causes of death and the way violence had been perpetrated. The greater part of victims and offenders had been males originating from lower social strata. Most of the victims and offenders had been in relationship with each other prior to the offence. Typical course of events: Victims and offenders, under influence of alcohol, became involved in a brawl, usually for trivial reasons, which soon led to physical fighting. When the victim had been knocked to the ground, the offender started forceful kicking. Bleeding to death and head injury were frequent causes of death. More than 50% of all offences were committed by single offenders. The diagnosis of kicking to death can at best be derived from presence of boot traces leaving shaped injuries. The trace-generating boot can be identified as offending tool by means of comparative police investigation. In addition to evaluation of shoe sole profiles, there is other trace-relevant material that may be sampled from a suspected offender's footwear (skin cells, hair, blood, body tissue) and used to identify findings by DNA analysis. There may be injuries with visible patterns supporting suspicion of kicking and trampling, although conclusive confirmation can be obtained only by testimony by a witness or confession by the offender.

Adolescent↗
PubMed2002

Drug recognition expert evaluations made using limited data.

The Drug Evaluation Classification (DEC) Program is used by Drug Recognition Expert (DRE) officers to determine whether a suspect is under the influence of a drug or drugs at the time of arrest, and, if so, what category of drug(s). The goal of this project was to investigate the relative importance of face-to-face interactions with the suspect, physical evidence (drugs or paraphernalia found), and confessions/statements made by the suspect (or others) in making these determinations. Seventy records of DRE evaluations were selected from a database containing information from all evaluations conducted in Oregon between 1996 and 1998. Each of the 70 records represented a suspect who had either taken a drug from one of four categories (CNS depressant, CNS stimulant, narcotic analgesic, or cannabis) or who had not taken a drug. To be included, the original DRE evaluation and the subsequent toxicology analysis had to agree that the suspect was under the influence of a drug from one of the four categories or not under the influence of a drug. Records from the 70 cases were submitted in written form to 18 Oregon DREs with statements made by suspects or arresting officers, confessions, toxicology results, and descriptions of drugs or paraphernalia found on the suspect omitted. Based only on the written reports of direct observations, and with physiological and psychophysical test results, the DREs attempted to determine whether each of the 70 suspects was under the influence of a drug or drugs, and, if so, what category of drug(s). If the officers determined that a suspect was under the influence of a drug, their accuracy in specifying the drug category was 81% for cannabis, 94% for narcotic analgesics, 78% for CNS stimulants, and 69% for CNS depressants. Overall accuracy in recognizing drug intoxication was 95%. These percentages indicate that although face-to-face interactions, physical evidence, and confessions/statements can be useful adjuncts to DRE decision-making, the majority of drug category decisions can be made solely on the basis of recorded suspect observations and DRE evaluation results.

Humans↗
PubMed2003

Smothering of children older than 1 year of age-diagnostic significance of morphological findings.

A homicide by smothering may leave unobtrusive or even no injuries if the victim is not able to struggle. This is especially true for infants up to 12 months of age. The differentiation between the sudden infant death syndrome and smothering, by an autopsy alone may be impossible. To establish whether this is different in older children because of their rising capacity for defence six cases of smothering in children >1 year of age were re-examined. The age of the children ranged between 1.5 and 7 years (surviving child). The smothering was inflicted with hands in three cases (including the surviving child), with a pillow in two cases, and the way of smothering remained unknown in one case (no confession of the perpetrator). Depending on the tool used for smothering, abrasions on the facial skin (hands, lesser in cases of smothering by a pillow) and petechiae (pillow/hands) could be seen by external examination. The older the children were, the more injuries could be found. Together with circumstantial evidence all cases could have been established by a thorough autopsy. This is important to prevent further offences against (surviving) siblings.

Asphyxia↗
PubMed1998

Evidence for an antemortem injury of a burned head dissected from a burned body.

A 41-year-old woman was killed following blows to the head with a bat. Her body was burned and her head was dissected with a saw and hidden in the soil. Although the body was discovered within a few days of her death, the putrescent head was not located until four months later. A fracture of the left temporal bone was found in the head, which was partially charred. The confession of the murder suspect was unreliable, and the police suggested that the cause of death may not have been a head injury but asphyxia, and that the bone fracture to the head may have been caused after its dissection. It was therefore necessary to determine when the fracture was formed. The fracture line continued to the base of the skull, indicating that it was not due to heat. Magnetic resonance computed tomography (MR-CT) indicated the existence of a blood clot in the left mastoid cells, across which the fracture line passed. Upon sectioning of the skull with a saw, a dark red clot was located in the left mastoid cells, indicating that bleeding had occurred before the body was set alight. It seemed most logical to assume that the bone fracture was formed when the victim was alive, or before her body was burned.

Adult↗
PubMed1999

Adolescent girls investigated for sexual abuse: history, physical findings and legal outcome.

OBJECTIVE: The aim of the study was to summarize the history of assault and record the results of medicolegal examination in adolescent girls under investigation for alleged sexual abuse, and to monitor the outcome of the legal process. The investigation period was 1990-94. METHOD: A consecutive series of 94 0-para girls, aged 9-22, median age 15.0 years, were examined in the head-to-toe manner including anogenital examination. Girls were referred from investigating police and social authorities. Only non-acute examinations were performed. Findings considered consistent with abusive vaginal penetration were hymenal distortion including deep clefts, hymenal and vestibular scarring, and introital diameter permitting vaginal inspection with a 17 mm speculum in the absence of consensual intercourse. Perianal scarring was recorded. STD sampling was made on indication. Findings were documented on body sketches. Medicolegal conclusions were grouped into three categories according to history and physical findings. Information on the outcome of legal procedures was collected from referring authorities. RESULTS: For 82% (77/94) of the girls, referring agencies provided examining physicians with a detailed and consistent history of abuse, presented results comprise these 77 girls. Intrafamiliar abuse was alleged by 81% (62/77), onset prior to menarche by 53% (41/77), and repeated abuse by 74% (57/77) of the girls. Abusive genital penetration was reported by 77% (59/77) and anal penetration by 19% (14/77). Sequelae after admitted self-inflicted injury were found in 15% (12/77). Deep hymenal clefts and/or vestibular scars were found in 59% (35/59) of the girls reporting penetrative abuse, compared with 6% (1/16) when non-penetrative abuse was alleged, P < 0.001. Girls with experience of voluntary intercourse could all be examined with a 25 mm speculum. Of the 17 girls without experience of consensual intercourse but alleging abusive penetration, 47% (17/36) could easily be examined with a 17 mm speculum, compared to none of 13 reporting non-penetrative abuse, P < 0.001. Non-specific anal abnormalities occurred in 10 (13%) girls; more often when anal abuse was reported, P < 0.001. No specific STDs were found. The medicolegal conclusion supported a history of abusive genital penetration in 41 (69%) cases; findings were non-specific in 11 cases and a normal anogenital status was found in 25 cases. The alleged abuse of 34 of the 77 (44%) girls was tried in court. One suspect was acquitted, 32 men were convicted of the abuse of 33 girls. Eleven perpetrators admitted abuse, and their histories were in concordance with the abuse alleged by the victims, as well as with the physical findings. CONCLUSION: A medicolegal diagnosis of alleged non-acute cases of sexual abuse relies on a detailed history. Adolescent girls alleging abuse may exhibit signs of admittedly self-inflicted extragenital injury. Our findings confirm that non-penetrative sexual acts leave no lasting genital signs, but that repeated abusive genital penetration significantly more often than non-penetrative abuse leaves deep posterior hymenal clefts and/or vestibular scarring, and a hymenal opening allowing examination with 17-25 mm specula also in girls without experience of voluntary intercourse. In cases with a confessing perpetrator, no discordance was found between the history of the victim, medicolegal conclusion and the history of the perpetrator.

Adolescent↗
PubMed2001

Thriving in a changing environment.

Undeniably, working in an environment that challenges the status quo is not without its problems. Members of the service redesign teams who participated in the West Ottawa Valley Network experience confess that many times during the process they felt a threat to their own job security along with uncertainty about their future roles and responsibilities. June Merkley points out that "working outside one's "normal comfort level" in a non-traditional leadership role has it's own set of difficulties, and dealing with multiple network members adds a dimension of complexity not encountered at the single site level." But she believes that "the challenges encountered within the network are helping to broaden the scope of job knowledge and communication skills. This can only have a direct and positive impact on the day-to-day tasks, while providing value to both the employee and employer". As a career management strategy, healthcare managers should seek out opportunities beyond their normal range of accountability, participate in activities that encourage the growth of new skills or hone skills that are a bit rusty. Often these projects will cause some anxiety or discomfort but the rewards, both short and long term, far outweigh the short-term pain.

Career Mobility↗