bluuebunny/crossref_metadata_2025 huggingface dataset:
An Introduction to Computer Forensics
Authors: FURNEAUX NICK
Published: February 2010

This paper provides an introduction to the discipline of Computer Forensics. With computers being involved in an increasing number, and type, of crimes the trace data left on electronic media can play a vital part in the legal process. To ensure acceptance by the courts, accepted processes and procedures have to be adopted and demonstrated which are not dissimilar to the issues surrounding traditional forensic investigations.

This paper provides a straightforward overview of the three steps involved in the examination of digital media:

• Acquisition of data

• Investigation of evidence

• Reporting and presentation of evidence

Although many of the traditional readers of Medicine, Science and the Law are those involved in the biological aspects of forensics, I believe that both disciplines can learn from each other, with electronic evidence being more readily sought and considered by the legal community and the long, tried and tested scientific methods of the forensic community being shared and adopted by the computer forensic world.
Muti Killing
Authors: BHOOTRA B L , WEISS E.
Published: February 2010

Muti killings are a form of murder committed by certain African tribes in South Africa and other African countries. Body parts for medicinal and ritualistic purposes are removed whilst the victims, mostly women and children, are still alive.

The authors report the case of a 10-year-old boy who was found in an unconscious state in the undergrowth near a rural village in Limpopo, South Africa. He had several injuries which included the removal of his private parts and severe head injuries. The incidence, etiological and cultural factors, predisposing conditions and legal questions arising from such deaths are discussed.
The Use of Histology in 638 Coronial Post-Mortem Examinations of Adults: An audit
Authors: LANGLOIS NEIL E I
Published: February 2010

An audit was performed to determine the effectiveness of histological sampling of forensic post-mortem cases based on a review of three years' data, which comprised 638 adult autopsy cases. During the study period organs and tissues that appeared macroscopically normal and abnormal were extensively sampled. Histology was regarded as in some way contributory (providing, altering or confirming a cause of death) 53% of the time. The use of histology provided the cause of death in 49 (24%) of the 203 cases not given a cause of death after the completion of the macroscopic examination. When an interim cause of death had been supplied following the completion of the gross examination it was changed in 4.8% of cases, but there were no changes of the manner of death. The majority of the histological diagnoses or discrepancies involved the lungs and the heart. All diagnoses relevant to determining the cause of death would have been made if samples had been taken only from the left ventricle, right ventricle, coronary arteries, lungs, kidneys and brain with any tissue or organ that appeared abnormal macroscopically. A macroscopically identified abnormality that appeared to have been responsible for death was not sampled in 20 cases; consequently, more attention will be paid to sampling macroscopically abnormal tissues. As a result of this audit histology sampling practice has been revised and will be re-audited in the future.
Outcome of Referral to a Prison Mental Health Team
Authors: FRIEL ANDREA , WHITE TOM
Published: February 2010

This retrospective case note study describes the demographic, offence and diagnostic characteristics of 115 referrals made to a psychiatric service within HMP Perth between May 2003 and April 2004.

Twenty per cent of referrals were diagnosed with a major mental illness with remand prisoners having a higher overall prevalence. Nearly 70% had previous contact with psychiatric services, a similar percentage had previous substance misuse. Over 8% were transferred out of prison and over a quarter continued to be followed up at the end of the study period.

A wide range of index offences was seen. Over two-thirds had a previous history of offending and nearly 60% had a previous custodial sentence, reflecting a high degree of recidivism.

This study supports the high degree of psychiatric morbidity in the prison population shown in other studies. The role of a prison psychiatric service is discussed in the context of services to mentally disordered offenders.
Death Due to Railway-Related Suicidal Decapitation
Authors: DE GIORGIO FABIO , POLACCO MATTEO , PASCALI VINCENZO L. , OLIVA ANTONIO
Published: February 2010

In Italy, railway-related deaths give rise to extensive inquiries because it is mandatory for the public prosecutor to investigate the circumstances of death. For the railway embankment, normal traffic rules are not valid and the guilt of the engine driver usually cannot be proven. Consequently, these cases are very often declared as suicides without adequate evidence. Furthermore, there is a potential risk of confusion with homicide, body dismemberment or mutilation. Our medico-legal institutes are increasingly engaged with expert opinions on questions of accident, suicide or homicide because they lead to complications in the fields of insurance, criminal and civil law.
Artificial Penile Nodules – A Forensic Pathosociology Perspective
Authors: WILCHER GLENN
Published: February 2010

The article reports on four cases of penile modifications, known in medico-social literature as artificial penile nodules, observed during the external coronial autopsy examinations of three males of South-east Asian origin, admitted over a five-week period, and a Australian youth admitted 30 months previously as a death in custody.

Fang muk, bulletus, chagan balls, tancho balls, and penis marbles are terms synonymous with the ethno-sexual practices of various sub-cultural groups of South-east Asian males, the terminology being specific to the geographic region. It describes the implanting of firm spherical foreign objects, in the form of beads, in the subcutaneous tissue of the shaft of the penis proximal to the glans to allegedly enhance the sexual pleasure of females during sexual intercourse.

Non-Asian nationalities such as Romanians (Wolf and Kerl, 1991), Russians (Serour, 1993) Fijians (Scott and Norton, 1993) and Middle Eastern males have also adopted this practice within sub-cultural groups of society.

The article provides a brief historical account and the social, motivational, and occupational characteristics of individuals adopting this sexual practice and the surgical and health side effects of the implantation of artificial penile nodules, relating these aspects to the forensic cases observed.
Female Autoerotic Deaths – Still Often Overlooked
Authors: SAUVAGEAU ANNY , RACETTE STÉPHANIE
Published: February 2010

Female autoerotic deaths are less common than male ones and usually present in a less obvious way. Thus, such deaths can be easily overlooked, even by senior investigators, if the latter are not fully aware of the particularities of female autoerotic cases. We present the case of a 34-year-old woman, found dead in her apartment, with several foreign body insertions and a dog leash around the neck. Despite the great experience of the investigative team, autoerotic death was not considered at first. This case illustrates the importance of forensic teams having knowledge of the particularities of female autoerotic deaths.
Statistics on trial
Authors: Dawid Philip
Published: February 2010

Although the concerns of Statistics and the Law might seem to have little to do with one other, they do share some fundamental common interests, such as interpretation of evidence, hypothesis testing and decision-making under uncertainty. Philip Dawid takes up questions that, though long of interest to a few scholars, have only recently become the focus of much attention.
Gender identity disorder and its medico-legal considerations
Authors: Sharma B.R.
Published: February 2010

The general belief among behavioural scientists and physicians is that gender identity disorder or transsexualism is an identifiable and incapacitating disease which can be diagnosed and successfully treated by reassignment surgery in carefully selected patients. Although many advances have been made in the reassignment surgery techniques, phalloplasty still remains a major challenge; to date, no ideal technique has been developed. The new gender created by the reassignment surgery has, in turn, led to many legal complications for post-operative transsexuals because, in many developed and the developing countries, transsexuals are not given a legal identity, thereby adding to their agonies and miseries. This article examines the historical perspective, genesis and management of gender identity disorder, or transsexualism, and draws attention to the medico-legal considerations.
Widening the scope of the hybrid order
Authors: Whyte Séan , Gupta John
Published: February 2010

Hybrid orders under section 45A of the Mental Health Act allow for convicted mentally disordered offenders to be given a sentence of imprisonment and simultaneously transferred to hospital for psychiatric treatment. In England and Wales their use is limited to patients with psychopathic disorder and the order has been little used. Two recent judgments by the House of Lords and the Court of Appeal have interpreted the law in a manner which widens its scope, allowing treatment of a greater range of offenders under the order, including offenders with co-morbid mental illness.
A post-mortem study of the upper gastro-intestinal tract in head injury cases
Authors: Verma B. , Murari A. , Aggarwal K. , Rani Y.
Published: February 2010

A post-mortem study was conducted to find the incidence, morphological changes and distribution of lesions in the upper gastro-intestinal tract (GIT) in victims of head injury who had survived for 24 hours or longer. The study involved naked eye and microscopic examination of the mucosa of the upper gastro-intestinal tract. In this study all the victims of head injury who had survived one or more days showed definite evidence of damage to the lining of the stomach wall. The severity of the damage increased with survival time. The damage observed was in the form of congestion, mucosal haemorrhage, superficial erosions, and superficial ulcerations accompanied by frank haemorrhage.
Trends in fatal motor vehicle accidents in Transkei region of South Africa
Authors: Meel B.L.
Published: February 2010

This paper aims to estimate the incidence of motor vehicle accident (MVA) related deaths and identify the factors associated with the causes of the high road death toll in Transkei region.

A retrospective review and analysis was performed of all medico-legal autopsies (n=6181) between January 1993 and December 1999, of which 39% (1,778/4,525) were deaths as a result of MVAs.

During the seven-year period (January 1993-December 1999), MVA deaths in Transkei region accounted for an average of 63 deaths per 100,000 population per year. It reached a peak of 80 deaths per 100,000 in 1997, and then slowly came down to 48 deaths per 100,000 in 1999. MVA deaths have come down from 39% (248) of all trauma-related deaths in 1993 to 29% (193) in 1999. The male/female ratio is 3.3:1; and 50% of victims were between 21 and 40 years of age. In conclusion, there are high motor vehicle accident-related deaths in Transkei region of South Africa.
Misleading statistics within criminal trials
Authors: Nobles Richard , Schiff David
Published: February 2010

Richard Nobles and David Schiff revisit the Sally Clark case and consider the presentation by non-statisticians of statistical evidence in court.
Post-anaesthetic maternal death in a patient with mediastinal large B-cell lymphoma
Authors: Lau Gilbert
Published: February 2010

A 32-year-old female underwent laparoscopic salpingectomy of an ectopic (third) pregnancy under general anaesthesia, at approximately six weeks' amenorrhoea. She developed severe respiratory distress after extubation and died on the second postoperative day. It appears that she had a history of a mild, persistent productive cough for a period of about a month prior to the operation that was attributed to an upper respiratory tract infection. Autopsy demonstrated the presence of a large mediastinal tumour, whose existence was apparently unsuspected preoperatively, encasing the ascending thoracic aorta, aortic arch and the proximal segments of the brachiocephalic and subclavian arteries, and causing extrinsic airway compression. Subsequent microscopic examination showed histological and immunohistochemical features of a mediastinal large B-cell lymphoma. It is thought that the mechanical effects exerted by the advanced mediastinal tumour upon the airways and the thoracic cage, coupled with the pathophysiological effects of general anaesthesia on respiratory movement and airway patency, had led to the patient's unfortunate demise in early pregnancy.
Sudden unexpected death associated with lymphocytic thyroiditis
Authors: Vestergaard Vibeke , Drostrup Dorthe Høj , Thomsen Jørgen L.
Published: February 2010

A forensic autopsy study comprising 125 cases was carried out retrospectively in order to evaluate pathological changes in the thyroid gland in different groups of death. The five groups selected consecutively were: (i) opiate addicts who died from an overdose, (ii) alcoholics who died as a result of their alcohol abuse, (iii) cases of fatal poisoning other than opiate addicts, (iv) unknown cause of death and (v) controls without prior disease. Tissue samples from the thyroid gland were cut and stained with haematoxylin and eosin and van Gieson. Histology examinations were subsequently performed blind with semiquantitative assessment of the following six parameters: (a) height of the follicular epithelium, (b) the amount of lymphocytes, (c) the presence of plasma cells, (d) hyperplastic follicular changes, (e) oxyphilic changes, and (f) fibrosis.

The most striking result was the finding of extensive lymphocytic infiltration of the thyroid parenchyma in five of the 124 cases, of which four belonged in the group of `unknown cause of death'. This discovery leads to reflections regarding lymphocytic thyroiditis as a cause of death, either by itself or in combination with other disorders. Silent (painless) thyroiditis, especially, is easily overlooked at autopsy as there are no macroscopic changes and often no prior symptoms or history of thyroid disease pointing towards this condition. Analyses of thyroid hormones are unreliable in predicting endocrine status in life. Routine microscopy of the thyroid gland is therefore advocated in cases of sudden unexpected death in order to diagnose thyroid disease, in particular silent (painless) thyroiditis.
Sudden natural deaths in Edirne, Turkey, from 1984 to 2005
Authors: Azmak Ali Derya
Published: February 2010

The aim of this study is to evaluate the characteristics of sudden natural deaths (SND) in forensic autopsy cases which were performed in Trakya University Department of Forensic Medicine, Edirne, Turkey. For each case, a complete autopsy, toxicological screening and histological examination were performed. Deaths due to unnatural causes, alcohol, drug overdose and undetermined causes (negative autopsy) were excluded from the study.

Autopsy reports of 959 consecutive forensic cases performed in a 22-year period were reviewed. Two hundred and seventy-eight (278) SNDs were identified, involving 232 males (83.4%) and 46 females (16.6%). The age group of 50-59 years accounted for 21.58% of the cases. In the majority (55%) the cause of death was related to the cardiovascular system – principally ischemic heart disease. The second most common cause of SND was related to the respiratory system (19.1%), especially pneumonia. Most of the SNDs occurred in the winter months. Ethyl alcohol was detected in 5.3% of cases.

In conclusion, sudden natural deaths related to the cardiovascular system are shown to be a significant problem in the Trakya region of Turkey.
Filigree burn of lightning
Authors: Kumar Virendra
Published: February 2010

Lightning is a powerful natural electrostatic discharge produced during a thunderstorm. The electric current passing through the discharge channels is direct with a potential of 1000 million volts or more. Lightning can kill or injure a person by a direct strike, a side-flash, or conduction through another object. Lightning can cause a variety of injuries in the skin and the cardiovascular, neurological and ophthalmic systems. Filigree burn of lightning is a superficial burn and very rare. Two cases of death from lightning which have this rare finding are reported and discussed.
Ethical problems in the investigation of autoerotic deaths
Authors: Schoendorff Patrice , Lamothe Pierre , Fanton Laurent , Malicier Daniel , Sauvageau Anny
Published: February 2010

Despite a large body of literature on autoerotic deaths, there are very few articles focusing on the ethical aspect of such deaths. Furthermore, as far as we know, there is no paper that has studied the forensic teams' reactions to those deaths. We present three cases of autoerotic death involving ethical problems in the case's management. Despite the usual high professionalism and respectful behaviour of the forensic staff, we observed in these cases breaches of confidentiality, laxity of work and an offhand attitude. Ethical dimensions are discussed.
Recognition by French courts of compensation for post-vaccination multiple sclerosis: the consequences with regard to expert practice
Authors: Rougé-Maillart C.I. , Guillaume N. , Jousset N. , Penneau M.
Published: February 2010

Over the past few years, despite scientific uncertainties, French courts have awarded compensation to sufferers of multiple sclerosis (MS) which occurred following vaccination against hepatitis B. These legal decisions have aroused fierce criticism in the medical world. Both a judgment given on 25 May 2004 by the Court of Cassation and a new publication in the journal Neurology have encouraged us to look once more at this controversial issue. French judges began compensating patients with MS at the end of the 1990s.

One of the first judgments was given in 2001 by the Court of Appeal of Versailles when a pharmaceutical laboratory was held liable for the onset of MS following vaccination against hepatitis B. On appeal, the Court of Cassation overturned the judgment in September 2003, finding that the Court of Appeal judges had based their decision on a hypothetical causal link. However, the only reason why the Court of Appeal judgment was quashed was the contradictory evidence on which the judges had based their presumptions. Several of the judgments given since that date seem to confirm this hypothesis. On 25 May 2004, the 2nd civil law chamber recognized that MS which occurs following a vaccination against hepatitis B (a vaccination carried out for work-related purposes) could be considered as an accident at work, without questioning the possible causal link between the illness and the vaccine.

This jurisprudence in the matter of hepatitis B vaccination shows the need for great care in expert practice. Effectively, when confronted with drug related imputability, the expert usually bases his reasoning on three points: the causal role of the generating factor, the chronology and other causes of damage. In terms of MS, all these factors are modified. More than ever, an expert must, in terms of imputability, be objective, prudent and clear in his conclusions.
Gender differences amongst adult arsonists at psychiatric assessment
Authors: Dickens Geoff , Sugarman Philip , Ahmad Farooq , Edgar Simon , Hofberg Kristina , Tewari Sidharta
Published: February 2010

Reports of gender differences amongst arsonists at psychiatric assessment are not uncommon, however some are based on relatively small samples. A new retrospective study highlighting gender differences could help to confirm or refute the current state of knowledge. The aim of the current study was to examine gender differences amongst a sample of 167 adult arsonists (129 males and 38 females). Information was collected from clinical records on socio-demographic, family background and childhood factors; adult adjustment; fire setting history; motives; features of pyromania and other offending, from the case notes of a group of arsonists referred to the West Midlands Psychiatry Service over a 24-year period. Female arsonists were older than males and more likely to have a psychiatric diagnosis. Women more frequently had a history of sexual abuse, while men had a more varied criminal background and more substance abuse problems. Our findings largely support previous research, and are discussed in this context, whilst also bringing attention to a more recently developed theory (Action System Model). Significant gender differences amongst arsonists indicates that different emphases in the treatment of male and female arsonists may be advisable, though a reliable evidence base for treatment has yet to be established.
Utility of the caput succedaneum in the forensic investigation of neonaticide
Authors: Sauvageau Anny , Belley-Coôté Émilie P. , Racette Stéphanie
Published: February 2010

Suspicion of neonaticide often leads to a request for a forensic autopsy. In that setting, it is important to correlate autopsy findings with the history given by the mother. So far, caput succedaneum has not raised interest in forensic pathology. A caput succedaneum is a haemorrhagic oedema involving the skin and superficial fascia of the head that results from circulatory stasis caused by compression exerted by the uterus or cervix on the presenting part. It is usually seen with prolonged labour. We report a case of caput succedaneum in a forensic autopsy that overturned the mother's history of giving birth suddenly, consequently increasing the evidence of neonaticide.
Unplanned complex suicide by self-strangulation associated with multiple sharp force injuries
Authors: Palmiere Cristian , Risso Enrico , van Hecke Oliver , La Harpe Romano
Published: February 2010

In cases of ligature strangulation, the importance of distinguishing self-inflicted death from homicide is crucial. This entails objective scene investigation, autopsy and anamnesis in order to elucidate the manner of death correctly.

The authors report a case of unplanned complex suicide by means of self-strangulation and multiple sharp force injury. The use of more than one suicide method, consecutively — termed unplanned complex suicide — gives this case particular significance. A brief discussion on this uncommon method of suicide is presented, particularly relevant to the attending forensic physician. In addition, a short overview of the entity of complex suicide is given.
Suicide by homemade firearm
Authors: Singh B.P.
Published: February 2010

This paper presents a unique case of suicide committed by a homemade firearm. A 56-year-old man shot himself with a homemade firearm capable of accommodating and firing 8 mm rifle ammunition. The victim put the muzzle of the weapon on the right side of his skull and died immediately after firing. The overall and barrel lengths of the firearm were 29.5 cm and 17.5 cm respectively. The barrel was oversized for the 8 mm rifle bullet having an average muzzle and breech diameter of .423in. (9.53 mm) and .489in. (11.02 mm) respectively. The cartridge case recovered from the chamber was swollen due to the oversized non-standard chamber. The bullet recovered was deformed and elongated. The injury and bullet track present on the victim's head were unique in nature. With respect to the weapon and ammunition, this study represents an unusual suicide. The findings will be helpful to the medico-legal experts, forensic scientists and pathologists.
Two entrances, one exit — an atypical shotgun injury
Authors: De Giorgio Fabio , Rainio Juha
Published: February 2010

Firearm-related injuries are a major problem worldwide and one of the central issues in forensic pathology. An atypical appearance of a gunshot wound can create surgical or medico-legal diagnostic problems. We report a case of a homicidal shotgun fatality with an unusual trajectory of pellets in the body. Two large pellets perforated the anterior chest wall near to each other but made their exit through a common wound in the back. Our report describes the results of the medico-legal investigation and discusses problems related to examination of firearm wounds.
A devastating case of purpura fulminans in a young adult seven years after a splenectomy
Authors: De Salvia Alessandra , Lanzara Guido , De Leo Domenico
Published: February 2010

It is well known that asplenic patients can suffer immediate and long-term infective sequelae, most of all from capsulated bacteria, whereas appropriate immunization can reduce the incidence of post-splenectomy sepsis.

We discuss the case of a young adult developing an overwhelming post-splenectomy sepsis (OPSS) due to streptococcus pneumoniae seven years after the splenectomy for a traumatic injury. Neither immunoprophylaxis nor antibiotic therapy, whose value is underlined by literature data and international guidelines, was ever administered, either by the hospital physicians or by the general practitioner.
Mental Capacity Act 2005 – what do doctors know?
Authors: Schofield C.
Published: February 2010

The Mental Capacity Act 2005 was partially implemented in April 2007. Doctors should be aware of the Act and what implications it has on their clinical practice. This survey looked at the knowledge of physicians and psychiatrists regarding assessing capacity within the Act by means of a questionnaire.

The results showed that 100% of physicians and 70% of the psychiatrists answered questions wrongly in the questionnaire. Also, 97% of physicians and 70% of psychiatrists did not have some aspects of knowledge about capacity. Statistically significant differences in responses between physicians and psychiatrists were in relation to their knowledge of the existence and implementation of the Act. Answers were related to active schizophrenia, weighing up pros and cons, and recent assessment of incapability in relation to being by definition incapable.

This study shows that psychiatrists do slightly better in answering questions about the Mental Capacity Act 2005 and about capacity when compared with physicians, however both groups could improve their knowledge. With the full implementation of the Act in October 2007, this study shows the urgency and importance of training in the area of capacity for all doctors.
Referrals for expert psychiatric opinion on dangerous offenders: a survey of instructions regarding defendants liable on conviction to a statutory assessment of dangerousness
Authors: Bickle Andy , Stankard Paul
Published: February 2010

The Criminal Justice Act 2003 (“the Act”) introduced significant changes to the sentencing of violent and sexual offenders. The Act brought in a statutory assessment of dangerousness which includes a statutory assumption of dangerousness (“SAD”) for certain repeat offenders. Previously, expert psychiatric witnesses have commented on whether a defendant demonstrated sufficient mental instability to warrant a discretionary life sentence. Under this regime, psychiatric evidence is adduced to the assessment of dangerousness, especially for the purpose of supporting or undermining a rebuttal of the statutory assumption.

This study investigated how legal referrers are instructing psychiatrists in cases where on conviction there will be an automatic assumption that the offender is dangerous. The aim was to determine whether the requirements of the new law are being outlined to expert witnesses and how much notice is being given for the production of evidence. All referrals to a medium secure unit were surveyed over two years. Fifty-one referrals concerned defendants liable to the SAD on conviction. The majority of the SAD referrals (40 referrals = 78.4%) included no request to comment on risk or dangerousness. This figure did not fall over time as the Act became established. Only a small minority (5.9%) of instructions directed the psychiatrist to the relevant statutory provisions. On average, adequate notice appeared to be given for the production of evidence (45.6 days).

In the authors' view, legal referrers should make more explicit the requirements of psychiatric evidence in such cases. New legislation currently before Parliament would amend further the sentencing of such offenders, but there would remain a statutory assessment of dangerousness as the basis of sentencing violent and sexual offenders. Psychiatrists wishing to act as expert witnesses should be aware of the contents of the statutory assessment and be prepared to liaise with legal counsel to clarify instructions.
Organophosphorus poisoning: victim specific analysis of mortality and morbidity
Authors: Dash Shreemanta Kumar , Mohanty Manoj Kumar , Mohanty Sachidananda , Patnaik Kiran Kumar
Published: February 2010

The aim of this study was to evaluate the pattern of acute organophosphorous (OP) poisoning cases including death, duration of hospitalization and time lapse before arrival at hospital. All OP poisoning cases admitted to the Emergency Department of MKCG Medical College Hospital and other fatal cases received at the mortuary between September 1999 and August 2001 were prospectively studied. Males outnumbered females and most OP poisoning occurred in the 21-30 year age group. In 68 (97.1%) cases the motive was suicide and more than 80% were from rural areas. Nearly one-third of cases occurred during the summer and in the later part of the day. Married females and unmarried males were most frequently affected. Most of the married females were housewives and the males were students or farmers. Fifty-four per cent of cases were admitted for treatment within three hours with a mean time lapse of 6.2 hours. The mean hospital stay for all OP poisoning cases was 5.1 days. Twenty-nine out of 66 admitted OP poisoning cases were fatal. There is a high incidence of OP poisoning with mortality in the region. OP compounds are readily available at low cost in the market. A time of stress and frustration can lead to their use as a common poison with which to commit suicide.
Sudden death from ischaemic heart disease in a female patient with Sjögren syndrome
Authors: Inoue Hiromasa , Kinoshita Koji , Sugiyama Masafumi , Funauchi Masanori , Hanagama Masakazu , Nata Masayuki
Published: February 2010

Primary Sjögren syndrome (SjS) has a comparatively good prognosis except when it is complicated by non-Hodgkin's lymphoma. We performed an autopsy on a young female patient with primary SjS who had died suddenly during a meal, and we discuss the relationship between primary SjS and the cause of death. Eosinophilic change of the cardiomyocytes and severe arteriolosclerosis were observed within the myocardium. In the conduction system, lymphocyte infiltration was detected in the bundle of His, in addition to arteriosclerosis in the sinoatrial node and atrioventricular node arteries. The cause of death was diagnosed as ischaemic heart disease induced by arteriolosclerosis: its development can probably be attributed mostly to primary SjS. It should thus be kept in mind that primary SjS can occasionally result in the development of cardiovascular complications, such as ischaemic heart disease, as well as systemic lupus erythematosus or rheumatoid arthritis.
Use of seclusion in an English high security hospital
Authors: Pannu H. , Milne S.
Published: February 2010

There is a paucity of information about the use of seclusion in secure settings. The aim of this paper was to establish if any significant trends could be found for its use in a high secure setting. A retrospective descriptive survey of seclusions occurring over a one-year period at Rampton Hospital was utilised. Of the 443 patients within the study sample, 131 (29.6%) were involved in episodes of seclusion. Forty-five per cent of women experienced episodes of seclusion as opposed to 27% of men (p=0.004). Women were secluded at an average of 11.4 times, mostly following threatening behaviour, whereas males were secluded at an average of 4.3 times (p=0.03). There were two peak times for initiation of seclusion — 10.00 hrs and 17.00 hrs. The survey concluded that women were nearly twice as likely to be secluded as men and averaged three times as many episodes of seclusion. Younger patients were more likely to experience seclusion and spent longer periods of time in seclusion. No statistically significant differences were found between the use of seclusion and ethnicity. The observations related to female patients were particularly interesting and further studies on seclusion are required to inform upon strategies to minimise its use, with specific attention to female patients.
Prisoners' insomnia: to treat or not to treat? Medical decision-making in places of detention
Authors: Elger Bernice S.
Published: February 2010

Insomnia is a frequent reason for medical and psychiatric consultation in prisons. Medical decision-making in correctional health care should be based on the same principles as outside correctional institutions. In places of detention, principles should be balanced according to the same criteria as outside correctional institutions, while taking into account the unique harm-benefit ratios related to the specific context.

The aim of this paper was to examine the existing attitudes and ethical issues related to decision-making about insomnia evaluation and treatment in places of detention.

An analysis of the ethical issues and an evidence-based review of the consequences of different attitudes and treatments with regard to prison medicine were carried out.

Insomnia is a public health problem and requires adequate evaluation and treatment to avoid more serious health consequences both within and outside correctional institutions. Insomnia treatment in places of detention is an ethical dilemma, but there is no evidence-based reason to avoid benzodiazepines in prison completely and to use only neuroleptics and antidepressants, which might represent more dangerous and less efficient treatment.

In prison medicine, should we even treat insomnia? Widely accepted ethical strategies of decision-making indicate that we should. Institutional guidelines on insomnia should be based on ethically sound decision-making that takes into account the available evidence.
Rupture of a splenic artery aneurysm during pregnancy with maternal and foetal death
Authors: Lynch Matthew J. , Woodford Noel W.F.
Published: February 2010

Aneurysms of the splenic artery are rare although they are the most common of the so-called visceral artery aneurysms. First described by Beaussier in 1770, approximately 400 cases have now been reported in the literature. There is a strong association with pregnancy and since Corson's first description of the death of a mother in the third trimester from rupture of a splenic artery aneurysm, some 25% of reported cases have involved pregnant women. Arterial rupture is an obstetric emergency and associated with maternal and foetal mortality rates approaching 75% and 95% respectively. There are only 14 reported instances where both mother and baby survived. The clinical presentation is protean and in most cases splenic artery aneurysm is identified unexpectedly at angiography, laparotomy or post-mortem examination.
Cervical soft tissue lesions in the shaken infant syndrome
Authors: Porzionato Andrea , Macchi Veronica , Aprile Anna , De Caro Raffaele
Published: February 2010

Cervical soft tissue lesions have rarely been described in the shaken baby syndrome; they include ruptures of intervertebral discs and haemorrhages in the ligamenta flava, and in the interspinal and sternocleidomastoid muscles. We present here the autopsy case of a 30-month old girl who suffered an assault with multiple injury mechanisms, i.e., beating, sexual abuse and shaking trauma. External examination of the neck did not reveal bruises or excoriations, but cervical dissection showed haemorrhagic infiltration of the clavicular head of the sternocleidomastoid muscle, carotid region, posterior musculature of the pharynx and oesophagus, and retro-pharyngeal/oesophageal spaces. These findings were ascribed to the repeated violent movements of shaking trauma. The case presented confirms the occurrence of cervical soft tissue lesions in the shaken baby syndrome and reports injuries which have not previously been described. In suspected cases of shaken baby syndrome, particular attention must be paid to the examination of cervical soft tissue structures.
Sudden unexpected death probably due to Eagle's syndrome
Authors: Ruwanpura P. Rohan , Abeygunasekera Anuruddha M. , Tikiri Gunathilake K.M.B.
Published: February 2010

An abnormally long styloid process producing autonomic effects gives rise to Eagle's syndrome. Sudden deaths have not been previously reported. We present the case of a 39-year-old female who died of probable vagus mediated cardiac inhibition due to Eagle's syndrome. The diagnosis was established only after the autopsy examination, which revealed the elongation of the styloid processes in the form of fibrous membranes, compressing both carotid sinuses. The anatomical changes were not visible in the radiological films.
Cause of death in judicial hanging: a review and case study
Authors: Hellier Catherine , Connolly Robert
Published: February 2010

The cause of death in judicial hanging is controversial and often attributed to `hangman's fracture' of the second cervical vertebra. Research has shown that such fractures are the exception in judicial hangings and the cause of death can be attributed to a range of head and neck injuries, particularly compression or rupture of the vertebral and carotid arteries leading to cerebral ischaemia. The rapidity of loss of consciousness and death is highly dependent upon knot positioning and the length of drop which has varied through the history of hanging as a capital punishment in the UK.

The skeletal remains of Mr. George Kelly, wrongfully hanged for murder at Walton prison, Liverpool (1950) were exhumed, examined and are reported on herein. The first cervical vertebra was found to be fractured but no `hangman's fracture' of the axis – second cervical vertebra – was present. The hangman (Mr. Albert Pierrepoint) has been quoted as stating that the hanging of Mr Kelly took longer than `it should have' (Dernley and Newman, 1989) but no skeletal evidence of death by strangulation was found by the authors. Unconsciousness, if not death, would probably have been rapid due to vertebral artery damage as a result of the observed neck fracture, although this cannot be concluded with absolute certainty.
Pathology of firearm mortalities in the Niger Delta region of Nigeria: a study of 136 consecutive autopsies
Authors: Seleye-Fubara D. , Etebu E.N. , Bob-Yellowe E.
Published: February 2010

A prospective autopsy study of firearms-related death was carried out by the authors in the Niger Delta region of Nigeria. The purpose of the study was to evaluate the pattern, frequency, and anatomical sites of wounds, also the cause of death and the age and sex distribution of victims. The autopsies were performed after being served with the coroner's inquest forms. In all cases standard autopsy procedures were adopted and reports issued.

A total of 136 consecutive firearm deaths were autopsied. There were 122 (89.7%) males and 14 (10.3%) females, giving a male to female ratio of 8.7:1. The highest number of deaths, 95 (69.8%), occurred in the age group of 10–39 years with a peak of 51 (37.5%) deaths at 20–29 years. In 112 (82.4%) cases death occurred from homicidal gunshot wounds. The commonest targets of gunshot wounds were the head, 58 (42.6%); multiple anatomical sites, 30 (22.1%); chest, 16 (11.8%); abdomen, 11 (8.1%) and neck, 10 (7.4%). Haemorrhagic shock was the cause of death in 131 (96.3%) cases.

Significant causes of traumatic death in the Niger Delta region of Nigeria are gunshot wounds and associated complications. Stringent laws on illegal firearms handling should be passed and enforced by the government to reduce the frequency of such deaths.
Homicide by organophosphorus compound poisoning
Authors: Kumar Lavlesh , Agarwal Swapnil Sudhirkumar , Chavali Krishnadutt H. , Mestri Shashidhar Channamallappa
Published: February 2010

Pesticides are responsible for less than 1% of deaths from poisoning in the UK while various studies in India indicate that the figures range from 20% to a staggering 70% (Sharma, 1998). Organophosphorus compounds are reported to be the most commonly used substances for suicidal purposes (Dixit, 2007). Homicidal poisoning involving pesticides has always been rare owing to the disagreeable odour and taste rendered to them by their hydrocarbon solvents (Pillay, 2008). An unusual case of homicide using an organophosphorus compound is presented here.

The body of a 28-year-old woman was brought for post-mortem examination at the mortuary of the Government Medical College and New Civil Hospital, Surat, Gujarat, India. It had been exhumed after forty-five days of burial under the supervision of a medical officer from the nearby primary health centre, the police and a magistrate. There was a history of marital discord between the deceased and her husband. Their ten-year-old daughter, who was the only witness to the incident, revealed later that her mother was struck by a wooden block and forcibly made to ingest some medicine. The ‘medicine’ was identified on chemical analysis as an organophosphorus compound (dichlorvos).
Challenges at the interface of working between mental health services and the criminal justice system
Authors: Hean Sarah , Warr Jerry , Staddon Sue
Published: February 2010

Provision of mental health reports for defendants in contact with the criminal justice system is problematic. This paper explores factors that facilitate the flow of information on a defendant between the courts and the mental health services. It identifies key challenges to this information transfer from a court worker's perspective. It also explores potential mismatches in the expectations held by the criminal justice system and the mental health services of the timeframes in which reports should be delivered and examines the perceived usefulness of reports.

In Part 1, questionnaires were distributed to a population of 2,107 court workers. In Part 2, monitoring forms were completed by court and health professionals on each report request made over a seven month period. Three key challenges to information transfer were identified: delays in report production, perceived inadequacies in the report content and report funding. Perceived timelines within which respondents believed reports should be delivered varied and there is a mismatch between the expectations of the two services. Perceptions on the usefulness of court reports also varied.

Poor inter-agency communications are caused by lack of a clear, shared protocol outlining agreed timelines, report content and lines of responsibility relating to resource provision. Clear service level agreements are required between services to achieve clarity.
Complex regional pain syndrome: the role of the psychiatrist as an expert witness
Authors: Neal Leigh A.
Published: February 2010

Complex regional pain syndrome (CRPS) is a regional pain syndrome of unclear pathophysiology, typically affecting the hand or foot. CRPS can be subject to personal injury litigation and may be the cause of substantial future loss of earnings claims. In clinical practice, a variety of medical experts can be involved in the diagnosis and management of CRPS and this can lead to confusion about the most appropriate expert for lawyers to instruct. This paper defines the role of psychiatrists as experts to the court in CRPS and reviews the associated psychiatric literature. Psychiatrists do not have expertise in the clinical diagnosis of CRPS, but they are able to assess the presence of co-morbid psychiatric conditions. They can assist the court as experts in the underlying neuro-physiological and psychological processes which may explain some of the important features of CRPS and an individual's psychological vulnerability to CRPS. Their expertise in psychological and psycho-pharmacological interventions should be considered for any multidisciplinary treatment programme for CRPS along with the likely contribution of these interventions to the overall prognosis.
Outcome of high security patients admitted to a medium secure unit: the Edenfield Centre study
Authors: Blattner Regine , Dolan Mairead
Published: February 2010

This study examined the outcome of a cohort of 72 patients from a high secure psychiatric hospital (HSPH) who were admitted to and discharged from the Edenfield Centre over a 16-year period. The sample was predominately male and mentally ill and the majority was subject to restriction orders. Compared with two similar studies focusing specifically on the outcomes of HSPH patients in medium security, our sample had fewer women and the group had more extensive criminal and psychiatric histories. None of our cohort was discharged to the community via district services or transferred to other hospitals. We found that the Edenfield Centre had relatively higher rates of readmissions to the HSPH and a slightly higher reconviction rate than similar studies focusing solely on the outcomes of HSPH patients. In line with previous research, those detained under the legal category of psychopathic disorder were more likely to be reconvicted following discharge to the community than those detained under mental illness. Further large scale studies are needed to compare the outcomes of HSPH patients discharged through medium secure services that operate parallel or integrated aftercare service models.
Service audit of a forensic rehabilitation ward
Authors: Young Susan , Gudjonsson Gisli H. , Needham-Bennett Humphrey , Chick Kay
Published: February 2010

An open forensic rehabilitation ward provides an important link bridging the gap between secure and community provisions. This paper provides an audit of such a service by examining the records of an open forensic rehabilitation ward over a five-year period from 1 June 2000 until 31 May 2005. During the audit period there were 51 admissions, involving 45 different patients, and 50 discharges. The majority of the patients came from secure unit facilities, acute psychiatric wards or home. Thirty-nine patients were discharged either into hostels (66%) or their home (12%). The majority of patients (80%) had on admission a primary diagnosis of either schizophrenia or schizoaffective disorder. Most had an extensive forensic history. The focus of their admission was to assess and treat their mental illness/disorder and offending behaviour and this was successful as the majority of patients were transferred to a community placement after a mean of 15 months. It is essential that there is a well-integrated care pathway for forensic patients, involving constructive liaison with generic services and a well-structured treatment programme which integrates the key principles of the `recovery model' approach to care.
Suicide by burning barbecue charcoal
Authors: Brooks-Lim E.W.L. , Sadler D.W.
Published: February 2010

We report three cases of suicide in Scotland where barbecue charcoal was purposely burned in confined areas (an outbuilding, a car and a bedroom). External examination of the three cases revealed a distinctive `cherry red' discolouration to the post-mortem lividity and blood and there were no marks or injuries to the bodies to give any cause for concern. Toxicological analysis of femoral blood samples revealed fatal levels of carbon monoxide (70%, 85% and 80% respectively). Considering the history, circumstances and external findings, a `View and Grant' examination was conducted in all three cases and the cause of death was attributed to carbon monoxide poisoning due to inhalation of burning charcoal fumes. This particular method of suicide is not common in Europe and is more widely reported in the Far East.