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PubMed1987

Homicide as a cause of the sudden infant death syndrome.

The homicidal asphyxiation of a 10 1/2-month-old male infant and the attempted asphyxiation of his 4-month-old sibling, documented by parental confession, is presented as evidence that murder may sometimes be mistaken as sudden infant death syndrome (SIDS). A review of the literature of the relationship between murder and SIDS deaths reveals the suspicions of some physicians but few published cases; this reflects not only the difficulties of making a determination of murder by suffocation, since no injuries may be present, but also a lack of awareness among physicians who must evaluate infant deaths. It is recommended that murder should be considered in the differential diagnosis of sudden, unexpected death in infants and that the autopsy should include full-body x-rays and at least an initial look at the social history of the child.

Humans↗
PubMed1988

Consecutive infanticides in Japan.

A 34-year-old housewife who was arrested for patricide confessed that she had also killed six newborn infants between 1975 to 1983. She is the mother of four other children, and her husband frequently works away from home. Her motive seemed to be economic. In addition to this case, 11 other cases of three or more consecutive infanticides are recorded for the 8-year period between 1979 and 1986 in Japan. All of the suspects were the natural mothers of the murdered infants, and most of them were married. The infants were killed immediately after delivery by various methods of asphyxia, such as strangulation, throttling, smothering, or suffocation.

Adult↗
PubMed1989

The Podmore case.

On January 10, 1929, in Southampton, England, two men examining the interior of a long-padlocked garage that had been previously used as a storeroom by a local agent of the Wolf's Head Oil Company found the decomposing body of its missing agent, Vivian Messiter. The assistance of Scotland Yard was obtained. Sir Bernard Spilsbury's autopsy revealed that Messiter had died from several severe blunt force craniocerebral injuries, the murder weapon apparently being a blood-encrusted hammer found nearby. Suspicion immediately centered on William Podmore, alias William Thomas, who had been employed by Messiter for 3 days in late October 1928, immediately prior to Messiter's being declared missing. Podmore, who was wanted for fraud and robbery elsewhere in England, was questioned and told a self-serving story. Meanwhile, it had been suspected that he had reported to Messiter sales of oil to fictitious customers, collecting commissions on same, and this was eventually reinforced by the finding of traces of writing in a receipt book. Two fellow prisoners of Podmore stated that he had confessed in their presence. Almost 14 months after the murder, Podmore was charged with it. He was later convicted, and was hanged after some public outcry against the verdict.

England↗
PubMed1998

Homicide and the baby-sitter.

Two babies were smothered by their baby-sitter. The deaths happened 4 years apart. The baby-sitter was convicted based on a confession, not on the findings at autopsy. These cases illustrate the difficulty in distinguishing SIDS from suffocation homicide.

Adolescent↗
PubMed2001

A homicide in the Ukraine: DNA-based identification of a boiled, skeletonized, and varnished human skull, and of bone fragments found in a fireplace.

In an apartment, bone fragments were found in a fireplace. Furthermore, a varnished skull was found elsewhere in the same apartment. The tenant confessed to a murder and stated that the head of a victim, a girl, was boiled for 12 hours. He stated that the soft tissue was then removed and the skull was varnished. Other parts of the body were burned to ashes in an open field. Comparison of loci D19S252, CD4, CYAR04, TII01, F13A01, F13B, and D6S366 from the skull and the bone remains to loci of the mother of a missing girl showed that the skull came from that missing child. Biological maternity was calculated as 99.99%. The bone pieces were DNA typed as male and did not share alleles with the mother in several systems. Therefore, they belonged to a different (human) victim.

Bone and Bones↗
PubMed1976

Burn morbidity: a followup study of physical and psychological disability.

Fifty-one burn patients were studied in a retrospective manner to determine the effects of the burn injury on their ability to return to their pre-burn physical and social status. The results of this study indicate that: 1) 79% of the patients were able to return to work or school, though 45% required a change in work and 25% were not able to continue with their peer groups in school; 2) the average time of disability was 6 months; 3) there was a significant psychological morbidity as demonstrated by self-confessed depression, juvenile delinquency and divorce. There is a need for awareness of these problems so that proper counseling can be offered to the burn patient and his family both during his hospitalization and after discharge.

Absenteeism↗
PubMed1995

Traumatic solitary rectal ulcer in Saudi Arabia. A distinct entity?

Solitary rectal ulcer syndrome is a perplexing condition with a complex multifactorial pathophysiology. Inappropriate contraction of the puborectalis muscle and rectal mucosal prolapse have been commonly implicated, although self-induced trauma has been suspected in some cases. Eight patients who presented with rectal bleeding with excessive mucus were found to have an isolated rectal ulcer on proctosigmoidoscopy. Constipation, straining at stools, and pain in the anal region were present in seven of eight cases. All of them confessed to rectal digitation. Most of them had consulted more than two physicians and half of them had had barium enema and colonoscopy in the past. An ulcer was present on the anterior wall at 6-8 cm from the anal verge in seven of eight patients and none of them had either external or internal rectal prolapse. Rectal biopsy performed in six of eight showed histological findings consistent with the diagnosis of solitary rectal ulcer. Patients were convinced to stop finger evacuation and were given psyllium supplements. There was endoscopic healing with symptomatic improvement in the six patients who followed up for an average period of 38 weeks. We conclude that traumatic solitary rectal ulcer due to rectal digitation is a distinct entity and response to avoidance of this habit is good.

Adolescent↗
PubMed1980

Thermal injuries: the care of the whole child.

In commemorating and honoring the work of Everett Idris Evans we note the extraordinary developments in burn care which have taken place in intravenous therapy, control of infection, skin coverage, metabolism and diet, and the minimization of scarring and deformity. Probably a more important consideration is the emotional care of the burned child in relation to his grievous injury and disfigurement, to his relationship with his family and to his own expectations and those of all those in contact with him for his future, both social and economic. Without this emotional care we must confess that burn care is incomplete. References are made to the way in which the whole child should be cared for by the whole burn team and the principles underlying this. A special note is made of times of crisis to be encountered. The correct approach by trained people from the beginning of the illness and their patient continuation of contact as long as necessary will enormously reduce the suffering both the patients and their parents and will avoid many tragedies.

Adolescent↗
PubMed1980

Breast reconstruction after mastectomy: problems in position, size, and shape.

Having learned that healed mastectomy wounds will stretch sufficiently to accommodate an implanted prosthesis, we must pay more attention to the position, and shape of the breast mound created by the prosthesis. We have briefly discussed our methods and the considerations we feel are important in this regard, but, even after extensive experience, we confess that the problems are still with us. Clearly, surgical methods and prostheses must improve.

Adult↗
PubMedDate not supplied

Developing a web page: bringing clinics online.

Introducing clinical staff education, along with new policies and procedures, to over 50 different clinical sites can be a challenge. As any staff educator will confess, getting people to attend an educational inservice session can be difficult. Clinical staff request training, but no one has time to attend training sessions. Putting the training along with the policies and other information into "neat" concise packages via the computer and over the company's intranet was the way to go. However, how do you bring the clinics online when some of the clinical staff may still be reluctant to turn on their computers for anything other than to gather laboratory results? Developing an easy, fun, and accessible Web page was the answer. This article outlines the development of the first training Web page at the University of Wisconsin Medical Foundation, Madison, WI.

Attitude of Health Personnel↗
PubMed2005

Distinguishing inflicted versus accidental abdominal injuries in young children.

OBJECTIVES: To compare the presentation of young children with abdominal trauma caused by high-velocity accidental (HVA), low-velocity accidental (LVA), and inflicted injury, and to test the hypothesis that a delay in care is highly predictive of an inflicted injury. METHODS: We performed a retrospective chart review at an urban Level I pediatric trauma center between 1991 and 2001 of children younger than 6 years who were admitted with abdominal injuries and an Abbreviated Injury Scale (AIS) score > or = 2. Charts were abstracted for demographic information, history of presentation, mechanism of injury, and diagnoses. Accidental injuries were defined as high velocity (motor vehicle crash or a fall from > 10 feet) or low velocity (household trauma, bicycle crash, or a fall from < 10 feet). Inflicted trauma was defined as a constellation of unexplained injuries, confessions by a perpetrator, or disclosure by the victim. RESULTS: Of the 121 children in the study, 77 (64%) had HVA injuries, 31 (26%) had LVA injuries, and 13 (11%) had inflicted injuries. Solid organ injuries (e.g., liver, spleen, and kidney) were most common in all groups, and abused children were significantly more likely to have suffered a hollow viscus injury (p = 0.03). Abused children were also significantly more likely to have suffered injuries with an AIS score >3 and combined hollow viscus and solid organ injuries than the HVA group or the LVA group (p < 0.001). Presentation for medical care occurred within 12 hours for 100% of the HVA group but only 65% of the LVA group, and 46% of the abuse group (p < 0.001). Presentation to care at greater than 12 hours was neither specific nor highly predictive of abuse, as some children with LVA injuries presented for care late despite developing symptoms shortly after their injury occurred (specificity, 65% [95% confidence interval, 45-81%]; positive predictive value, 39% [95% confidence interval, 17-64%]). CONCLUSION: Young children with inflicted abdominal injuries are more likely to have more severe injuries, multiple injuries, and a delay in seeking care than young children with accidental abdominal trauma. However, delay in seeking care is not specific for inflicted injury and occurs in some children with LVA abdominal trauma.

Abbreviated Injury Scale↗
PubMed2000

The one that did not get away: individual assignment using microsatellite data detects a case of fishing competition fraud.

Assignment of an individual to the population from which it most probably originated based on its multilocus genotype has been widely applied in recent years. In this study, individual assignment based on microsatellite data was used to identify a case of fishing competition fraud. Despite the fact that the true population of origin was most probably not among the reference populations, recent modifications of the assignment tests were used in confidently excluding (p < 0.0001) the possibility of a 5.5 kg salmon (Salmo salar) originating from the fishing competition location, Lake Saimaa (south-east Finland). In fact, the probability of the suspect salmon originating from one of the regions that supply most of Finland's fish markets was found to be over 600 times higher than it originating from Lake Saimaa. When presented with this evidence, the offender confessed to purchasing the salmon at a local fish shop and criminal charges were laid. This study emphasizes the potential practical application of the individual assignment procedure, in particular the usefulness of confidently excluding populations as the origin of an individual. A similar strategy could be also used, for example in suspected cases of illegal poaching, in order to assign or exclude individuals from originating from a claimed population.

Alleles↗
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↗
PubMed2003

Classifying homicide offenders and predicting their characteristics from crime scene behavior.

A theoretical distinction between instrumental and expressive aggression was used in analyzing offender characteristics and their associations with crime scene actions in Finnish homicides. Twenty-one variables reflecting the offenders' criminal activity, previous relationships with intimates and victims, and general social and psychological adjustment were derived from files of single-offender/single-victim homicides occurring between 1980 and 1994 (n = 502). Additionally, three variables describing post-offense actions and police interview behavior were included. A multidimensional scaling procedure was used to investigate the interrelationships between the variables. A distinction between expressive and instrumental characteristics was observable in the empirical structure, which was divided into three subthemes of Instrumental, Expressive: Blood, and Expressive: Intimate. Associations between the characteristics with five previously identified subthemes of crime scene actions were computed. In addition, the subthemes of crime scene actions were related to post-offense actions and police interview behavior, with Expressive themes being associated with less denial as well as a greater likelihood of surrendering and confession. The practical usefulness for police investigations and theoretical implications of the results are discussed.

Adaptation, Psychological↗
PubMed2004

Boarding school: the trauma of the 'privileged' child.

Sending young children to boarding school may be considered a particularly British form of child abuse and social control. The trauma of the rupture with home may be followed by other ordeals such as emotional deprivation and, in extreme cases, physical and sexual abuse. The taboo on expressing emotion, which is common in such institutions, may lead to an encapsulation of the self. Consequently, the needs of the distressed child/self remain active, but unconscious, within the adult. This maybe disguised by an armoured, and very often socially successful, persona. The psychological interplay, between these two facets of the personality, may be detrimental to intimate relationships. In clinical practice the emotional conflict between a desire for intimacy and anticipated exile comes to the fore. Three examples demonstrate how within the transference this may lead to a dependent and erotic atmosphere, which abruptly changes to sever all connection. Changes in the frame, breaks in analysis, and confessions of emotional need are all points at which vigilance is required if such disturbance in analysis is not to end in its abrupt termination.

Adaptation, Psychological↗
PubMed2006

Self-inflicted garlic burns: our experience and literature review.

BACKGROUND: Throughout history, garlic has been used to treat a large variety of illnesses. One of garlic's adverse local effects is contact dermatitis. METHODS: We present three patients treated in the Department of Plastic Surgery for suspected self-inflicted lower extremity burns. RESULTS: The burns had unique features, not consistent with the etiology first claimed by the patients. All were soldiers with low motivation who confessed to using garlic to cause the burns. CONCLUSIONS: Garlic application usually results in local inflammation, but, if applied under a pressure bandage, or if there is poor wound care or a secondary infection, it can cause a severe dermal reaction and a deep chemical burn. We present these cases to increase physician awareness of the characteristics of self-inflicted garlic burns, and review the dermatotoxic effect.

Adult↗
PubMed2005

Inflammatory bowel disease in Iran: a review of 457 cases.

BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) was believed to be infrequent in Iran; however, unofficial reports have confessed the continuing rise in IBD in our country. METHODS: Demographic and clinical features, extraintestinal manifestations, extension of disease and complications of 401 patients with ulcerative colitis (UC), 47 with Crohn's disease (CD), and nine with indeterminatn colitis (IC) were assessed retrospectively. The exact course of physicians' visits of 250 IBD patient was asked through face-to-face interview. RESULTS: Mean age at diagnosis was 31.9 years in UC and 30.5 years in CD patients. The male to female ratio was 0.8 for UC and 1.3 for CD. The percentage of CD and UC patients who were non-smokers was 82.9 and 84.5%, respectively. Patients with UC presented with rectal bleeding (41.9%), whereas those with CD complained of abdominal pain (46.9%). Among UC patients, proctosigmoid was affected in 51.9%. Colorectal cancer was diagnosed in two patients. The mean lag time between the onset of symptoms and definite diagnosis was 13.9 and 17.7 months for UC and CD patients, respectively. A total of 32.4% of patients with IBD had at least one of the five major extra-intestinal diseases. CONCLUSION: The demographic and clinical picture of IBD is more or less the same as that of other developing countries; however, the rarity of CD in Iran is noted. Although the true epidemiologic profile of IBD in Iran is still unknown, it is not as rare as previously thought, and it seems as if gradual adoption of a Western lifestyle may be associated with the continuing rise in IBD.

Abdominal Pain↗
PubMed1976

Division of the external urethral sphincter in the neuropathic bladder: a twenty years' review.

It is now twenty years since the authors first performed division of the external sphincter region in the treatment of the neuropathic bladder. Although a ten year report was published in 1967, it was decided to review all the patients at the end of the twenty year period. The rationale of the operation in the upper motor neurone lesion has been confirmed by modern investigative techniques, while it appears from recent work that the success of the procedure in the lower motor neurone case is due to division of plain muscle which is subjected to excessive sympathetic stimulation. It is the authors' firm conviction that long term catheterization, whether permanent or intermittent is a confession of failure and can be avoided in the vast majority of patients. The operation has proved of permanent benefit especially with the regard to the elimination of residual urine. Further, hydronephrosis, and renal infection and failure, are also benefited in many cases. These factors are of great importance in a condition in which late morbidity and mortality has been usually due to renal causes.

Humans↗