Aspectos médico-legais do olho / Medicolegal aspects of the eye

RESUMO A oftalmologia fornece um campo vasto de conhecimentos necessários à medicina legal e às perícias médicas. O presente artigo objetivou revisar as informações na perícia criminal e cível, as repercussões da morte e os achados post-mortem que o exame ocular pode fornecer. Demonstrou-se que a perícia ocular é complexa e multifacetada, fornecendo ferramentas importantes para a classificação das lesões corporais, verificação da capacidade laboral, investigação da causa mortis e estimativa do tempo de morte.

ABSTRACT Ophthalmology provides a vast field of knowledge necessary for forensic medicine and medical expertise. The present article aimed to review the information on criminal and civil medical expertise, the repercussions of death, and the postmortem findings that the eye examination can provide. Ocular expertise has been shown to be complex and multifaceted, providing important tools to classify bodily injuries, verify work capacity, investigate the cause of death, and estimate the time of death.

Prevención Médico-Legal: Aplicación de la Matriz Foda a la Historia Clínica / Medico-Legal pervention of the SWOT (Strengths, Weaknesses, Opportunities, Threats) matrix to the clinic history

SWOT matrix is a strategic planning technique used to help to identify strengths, weaknesses, opportunities and threats related to project planning. SWOT matrx has been described as the tried-and-true tool for strategic analysis. Application of the SWOT matrix to the clinic history for its medico-legal evaluation, is referred

Lesión de dieulafoy en el yeyuno: presentación de caso y revisión de la literatura / Jejunal Dieulafoy ́s lesion: case report and literature review

La lesión de Dieulafoy es una causa poco frecuente de sangrado digestivo, en especial de sangrado digestivo bajo. Consiste en la presencia de un vaso arterial de gran calibre en la submucosa del tracto digestivo, que en algún momento sufre erosión de la mucosa supra yacentey la pared vascular provocando hemorragia intermitente, potencialmente fatal.El caso que se describe es el primero de lesión de Dieulafoy localizada en el yeyuno reportado en la literatura médica hondureña eilustra su presentación clínica y los hallazgos anatomopatológicos encontrados en la autopsia de un paciente masculino de 42años que falleció por choque hipovolémico. El diagnóstico de la lesión de Dieulafoy es histopatológico y se hace en las resecciones quirúrgicas o la autopsia, sin embargo, sus características endoscópicas permiten diagnosticarla con alguna seguridad y tratarla, salvando la vida del paciente sin requerir otros procedimientos mayores. En el presente caso, el paciente no pudo ser sometido aendoscopia porque se mantuvo hemodinámicamente inestable, sin poderse tratar, ni determinar la región del sangrado para guiar al cirujano en la laparotomía. El objetivo de esta publicación es comunicar acerca de una causa poco frecuente de sangrado digestivo, que siempre debe considerarse en el diagnóstico clínico diferencial y los hallazgos encontrados enla autopsia, ya que estos no son reportados con frecuencia en la literatura...(AU)

The Origin and Development of Medical Jurisprudence in Xiangya / 法医学杂志

The origin of medical jurisprudence in China can be traced back to as early as 1920s, and since then, the discipline has undergone a great development. This paper, based on the disciplinary development of medical jurisprudence at Xiangya School of Medicine, illustrates its evolution in three aspects covering the scientific and theoretic foundation, legal system and policy support. The current investigation reflected a glimpse of the modern forensic science in China, providing useful historical reference for the development of Chinese forensic science.

Análise de reconstruções faciais forenses digitais: proposta de protocolo piloto baseado em evidências / Forensic facial reconstructions analysis: proposal of a evidence-based pilot protocol

A reconstrução facial forense corresponde à construção facial de um indivíduo, realizada a partir de um crânio não identificado. Pode ser bidimensional ou tridimensional, realizada de forma manual ou digital. Neste último caso, o advento das novas tecnologias da informação em muito contribuiu, sobretudo no que diz respeito ao desenvolvimento de programas de imagem 3D, equipamentos de tomografia computadorizada e scanner 3D. Diferentes técnicas, equipamentos e softwares têm sido empregados com esta finalidade. A caracterização de reconstruções faciais com pelos como cabelo, cílios e sobrancelhas, tem sido questionada, sobretudo quando não há informação sobre tais dados. Este trabalho analisa reconstruções faciais forenses digitais 3D e, com base em evidências, propõe um protocolo piloto para a execução e apresentação das mesmas. Reconstruções faciais digitais, confeccionadas com o software 3ds Max, sem caracterização de pelos foram confeccionadas, utilizando três diferentes tabelas de espessura de tecidos moles, e submetidas a um teste de reconhecimento, por 22 examinadores. Em todos os casos, o sujeito-alvo foi o mais reconhecido, chegando a ser reconhecido por 45,45% dos avaliadores. É apresentada uma proposta de protocolo piloto para a confecção e apresentação de reconstruções faciais forenses. Para a confecção das mesmas, é empregado o software 3ds Max, e recomendado o emprego do software ZBrush para a pós-produção (como aposição de rugas e linhas). É impresso um protótipo da reconstrução facial, que pode facilitar o reconhecimento. Os autores afirmam que não deve ser realizada a caracterização com pelos, o que pode prejudicar o reconhecimento.

The forensic facial reconstruction corresponds to the rebuilding of the face of an individual, upon an unidentified skull. It can be two-dimensional or three-dimensional, performed manually or digitally. In the latter case, the advent of new information technologies has greatly contributed, especially with regard to the development of 3D image softwares, computed tomography and 3D scanner. Different techniques, equipments and softwares have been employed for this purpose. The characterization of facial reconstructions with hair, as hair, eyelashes and eyebrows, has been questioned, especially when there is no information about such data. This paper analyzes 3D digital forensic facial reconstructions and, based on evidence, proposes a pilot protocol for their confection and presentation. Digital facial reconstructions, made with 3ds Max software, without hair characterization, were made using three different tables of thickness of soft tissues. They were evaluated by 22 examiners, in a recognition test. In all cases, the target-subject was the most recognized subject, reaching the recognition rate of 45.45%. A proposal for a pilot protocol for the confection and presentation of forensic facial reconstructions is presented. The 3ds Max software is used to perform the facial reconstruction, and the ZBrush software to make the post-production (as wrinkles and lines). A prototype of the facial reconstruction is printed - it can facilitate the recognition of the subject. The authors state that the characterization with hair should not be performed, as it can impair the recognition.

Diagrammatic Reconstruction and its Application in Medico-legal Autopsies.

Head injury is a problem often encountered by both the clinicians and the Forensic Medical persons. Due to the doubtful positive outcome in case of clinicians and the consequent litigations in the court procedures, again these types of cases are generally apprehensive. Naturally the requirement of manner of the occurrences of the cases has become very important. Here lies the importance of Diagrammatic Reconstruction of such cases. Present work is a trial in this domain with an example.

Application of microperimeter in the visual function evaluation / 法医学杂志

In condition of direct vision on hindus of eye, microperimeter can quantitatively detect the retinal light sensitivity of macular area, and record real time tracking of the eye, automatically analyze the location and stability of fixation. Microperimeter matches hindus image with micro cyclogram point-to-point, thus it achieves the combination of visual function and structure. The characteristics of microperimeter have good relations with subjective vision, so it can be a new method for the accurate vision evaluation and has application potential to assess the visual function in legal medicine. In this article, we summarize the principle, method and parameters of microperimeter. Also, the applications of microperimeter in vision assessment are focused in order to provide a reference for the assessment of visual function in the legal medicine.

A role of digital imaging in identification of unidentified bodies.

Unidentified and unclaimed bodies for medico-legal autopsy has shown increased trend. Relatives of unidentified bodies suffer a lot of psychological trauma and also suffer in settling insurance, inheritance and pension claims. When an unidentified body has injuries on face, then photograph of such deceased is not accepted by print or electronic media for publication as such photograph may cause distress to the viewers. This study was conducted on three cases of unidentified and unclaimed bodies brought for medico-legal autopsy with facial injuries making their photographs unfit for publication in print or electronic media. Photograph of the deceased face was taken; image was transferred to a computer and by using Adobe Photoshop software CS2 and the injuries present on face were removed. The result showed that in all the three cases we could establish the identity by digital imaging. Relatives of the deceased could identify their missing relative by photograph shown to them after removal of injuries. Later on police confirmed the identification by using other methods of establishing identity. This method can be an aid in identification of unidentified bodies presented with facial injuries.

Study of coronary artery atherosclerosis in sudden deaths and its medico-legal relevance.

The coronary artery diseases can play a crucial medico- legal role to decide the cause of sudden death whether natural or unnatural. There are certain occasions, when a person dies on the operating table or soon after surgery, and a coronary attack is probably the cause of death. A final coronary episode may sometimes be associated with an operative procedure supposedly due to hypotensive state. During driving or piloting a person may goes into a state of confusion because heart attack. In this state he may lose control and an accident can happen. These conditions indicate that intervention of Forensic Pathologist is significant to decide the actual cause of death apart from injury or disease of vital organs. We examine coronary arteries for atherosclerotic changes in 50 cases of sudden deaths. We observed that there were marked intimal thickening with luminal narrowing ≤ 75% of luminal diameter in 20 cases (40%) in total hearts. In natural deaths 17 cases (48.57%) showed luminal narrowing ≤ 75% of luminal diameter. These findings are suggestive of medico legal intervention to clarify the mode of death in some instances.

Assessment of age in foetus: A medicolegal aspect.

A Medicolegal case of embryo/foetus was received from the department of forensic medicine for the assessment of age of the foetus. The report for the assessment of age was prepared on the basis of gross appearance, radiological and histological examinations. On radiological examination of the limb tissue, the age of the foetus /embryo was approximately 3 months. The ossification centres for metatarsal bones were visible which appear at the 10th week of intrauterine life. Also on USG the femur length was found to be 10 mm which also suggests the age to be around 3 months. The smooth junction between the epidermis and dermis suggests age of the embryo/foetus to be less than 3 months because the epidermal ridges and dermal papillae become prominent at the end of 3rd month. From the basal layer of epidermis down growths were seen which were suggestive of growth of hair follicles. Hair follicles become prominent by the 10th week of intra uterine life which again reveals that the age of foetus is around end of 3rd month. From the observations, the age of the foetus was found to be more than 2 and half months but less than 3 months i.e. between 10-12 weeks.