Post-mortem imaging of laryngohyoid fractures in strangulation incidents: first results.

Fractures and soft-tissue injuries of the neck are of great importance in forensic pathology, as they help in assessing whether strangulation took place, and if so, how severely. In this study, we examined the usefulness of post-mortem imaging with multislice computed tomography (MSCT) in detecting lesions of the laryngohyoid structures and the surrounding soft-tissues. For this purpose, we examined MSCT images of the neck of eight deceased persons who had suffered different types of strangulation and compared the findings with those obtained at the subsequent forensic autopsy. In six of the eight cases (75%), the fracture findings at autopsy were concordant with those found with MSCT. In the two non-congruent cases, MSCT revealed fractures, which were not discovered at autopsy. Soft-tissue haemorrhages were detected by autopsy in five cases, but only in one case with MSCT. MSCT does not suffice in detecting soft-tissue injuries. These preliminary results are promising regarding the detection of fractures in strangulation cases. If these results can be confirmed in larger studies, we believe that post-mortem MSCT may serve - in combination with a thorough external examination and a profound incident-scene investigation - as a useful decision-making tool regarding the necessity of further examinations, i.e. autopsy.

Injuries due to sharp trauma detected by post-mortem multislice computed tomography (MSCT): a feasibility study.

Modern cross-sectional imaging techniques are being increasingly implemented in forensic pathology. In order to assess the practicability of such a method, namely post-mortem multislice computed tomography (MSCT) in cases of fatal cut and stab injuries, 12 corpses underwent such an examination prior to forensic autopsy. The questions regarding detection of foreign bodies, wound channels, skeletal and organ injuries, as well as the cause of death were addressed at MSCT and autopsy. The results of the two techniques revealed that post-mortem MSCT a useful tool in the assessment of such injuries.

Incidence of auditory ossicle luxation and petrous bone fractures detected in post-mortem multislice computed tomography (MSCT).

As the auditory ossicles are difficult to display without harming them in conventional autopsies, lesions of these minute bones and the ossicular chain are regularly missed. In this study, the method of choice in clinical medicine for the examination of such lesions, namely multislice computed tomography, was applied to 100 corpses. The hereby obtained results regarding ossicle luxation and petrous bone fracture indicated that the lesions were not dependant on the amount, but rather on the type of energy inflicted to the head.

Gunshot injuries detected by post-mortem multislice computed tomography (MSCT): a feasibility study.

Modern cross-sectional imaging techniques are being increasingly implemented in forensic pathology. These methods may serve as an adjuvant to classic forensic autopsies or even replace them altogether in the future. In order to assess the practicability of such a method, namely post-mortem multislice computed tomography (MSCT) in fatal gunshot injuries, 22 corpses underwent such an examination prior to forensic autopsy. The cardinal questions of the location of entrance and exit wounds, the detection of bullets and bullet fragments in the body, the bullet course, inflicted injuries and cause of death were addressed at MSCT and autopsy. The results of the two techniques revealed that post-mortem MSCT can answer these questions reliably and is therefore a useful tool in the assessment of such injuries.

Virtopsy: fatal stab wounds to the skull--the relevance of ante-mortem and post-mortem radiological data in case reconstructions.

Homicides with a survival of several days are not uncommon in forensic routine work. Reconstructions of these cases by autopsy alone are very difficult and may occasionally lead to unsatisfying results. For the medico-legal reconstruction of these cases, ante-mortem and post-mortem radiological imaging should always be included in the expertise. We report on a case of fatal penetrating stab wounds to the skull in which a case reconstruction was only possible by combining the radiological ante- and post-mortem data with the autopsy findings.

Perforation of the pulmonary artery by a bronchial wall stent.

Implantation of stents into the bronchial walls is a newly developed method to treat lung emphysema, which is now being tested clinically. During this procedure, a bronchoscope carrying a Doppler ultrasonography head is placed into a segmental bronchus and the blood vessels running in parallel to the bronchus are localized. Once a safe location without blood vessels is found, the bronchial wall is perforated and a stent is placed within the wall to improve the expiratory volume of these "bypasses" to the adjacent lung parenchyma. We observed a fatal complication with this method in a 60-year-old man. The bronchial wall and the pulmonary artery were perforated by one of the stents inducing massive bleeding, which could not be stopped. The patient died due to aspiration of blood in combination with massive loss of blood. The general risk to perforate the pulmonary artery during this procedure cannot be estimated from this single observation but should be considered regarding the legal and clinical aspects.

Psychopathology and emotional distress among older high-utilizing health maintenance organization patients.

BACKGROUND: Rates of psychopathology are often underestimated in primary care populations, especially older patient groups. High medical utilization is often a reflection of psychopathology and/or emotional distress. Increased awareness of primary care patients' emotional distress can help to improve well-being and reduce unnecessary high utilization of medical services. This study aimed to assess the degree of psychopathology present in a sample of older health maintenance organization (HMO) patients who utilized higher-than-average amounts of medical services. METHODS: Patients in a large HMO aged 55 years old and older who exceeded the mean number of inpatient and outpatient visits in the past year were recruited. Sixty-nine patients, mostly female (69%) and white (93%), volunteered. Patients were assessed with the Medical Outcomes Study SF-36 health survey and the Symptom Checklist-90-Revised (SCL-90-R). RESULTS: Respondents made a mean of 41 visits in the previous year to medical providers, versus 24 visits per year for the average patient of this age in the HMO. Significant elevations on SCL-90-R global psychopathology, obsessive-compulsive, somatization, and depression scales were found. All patients met SCL-90-R criteria for psychiatric caseness. SF-36 health ratings were comparable with those of patients with chronic medical conditions assessed in other SF-36 samples. CONCLUSIONS: Older high-utilizing HMO patients show significantly more psychopathology and view their health status as poorer than that of other medical subpopulations; results suggest that care for these problems is rarely received.

Marital adjustment among housestaff and new attorneys.

Previous reports have suggested that physicians' marriages may be adversely affected by the stresses of the profession. Some social scientists, however, question the view that demanding careers are the primary cause of poor marital adjustment and suggest instead that such careers may actually invigorate a marriage. This study, involving 116 housestaff physicians, 106 new attorneys, and the spouses of both groups, identified the factors that significantly affected their marital adjustments. No difference in marital adjustments was found between housestaff and attorneys or between the two spouse groups. In general, the spouses had higher marital adjustment scores than did the professionals, and the women professionals had higher scores than did the men professionals. The two most important factors associated with adjustment were the perceived level of emotional support received from one's spouse for one's career and the level of such support given to one's spouse for his or her career. The results suggest that housestaff and new attorneys are as satisfied with their marriages as are the other populations in which the same marital inventory has been used.

Risk factors and the prevalence of depression in Mormon women.

A cross-sectional study was conducted in the Utah metropolitan area in which a random sample of white, married women with children 14 years of age or younger were interviewed by telephone. Information was obtained on possible risk factors for depression and depression was measured using the Beck Depression Inventory (BDI). Prevalence of depression was compared in Mormon women (N = 143) who have a high percentage of career homemakers and non-Mormon (N = 36) who have a high percentage of women working outside the home. No difference in prevalence of depression was noted. Risk factors for depression in Mormon women were also studied. After adjusting for confounding, the risk factors were: Less education, little perceived caring from spouse, perception of having less than good health and having a low income. These findings are compared to other studies.