Medico-Legal Journal最新文献

Adverse reactions to metal debris are inflammatory-necrotic changes that can occur in individuals with joint prostheses, particularly hips. They are triggered by the release of metal debris at both the periprosthetic tissue level and systemically. This was internationally recognised by 2012: several recommendations followed. Patients were advised to undergo careful clinical, laboratory and radiological follow-up with the potential need for prosthetic revision surgery. Concurrently, the primary manufacturers issued safety notifications and began recalling some prosthetic devices from the market. Notwithstanding, prosthetic implants with metal components continue to be widely used due to their favourable risk-benefit profile. We examined the cases of three patients whose hip arthroplasty had metal-type implants. Following the development of adverse reactions to metal debris, they underwent early prosthetic revision and even surgery to remove the prosthesis and clean up metal debris. Consequently, the patients requested a medico-legal evaluation to obtain compensation for the damage suffered. The investigations conducted in these three cases resulted in different allocations of liability: one to the manufacturing company, one to the healthcare professionals who treated the patients, one shared by both. This illustrates that, even after the risk has been identified, it remains a pertinent issue and provides insight into potential future scenarios regarding professional liability cases of a similar nature.

Geriatric suicide has specific characteristics that are not always clear. Our objective was to assess the characteristics of geriatric suicides at a precise moment in time, in a well-described population living in a particular geographic area (year 2003, Galatzi county, Romania).A unique, significant increase in all-ages suicide rates was observed in 2003. Geriatric suicide rates followed a different pattern. The local rate was significantly higher than the national one for two consecutive years (2003 and 2004). The difference between years was not significant. All suicide scenes were fully investigated by forensic teams. Medical history, chronic use of medication, heavy alcohol consumption, chronic pain, frailty and recent grief were mentioned in the history of most of the cases. The post-mortem histopathology findings were typical for the method of suicide used and similar for both analysed years. 75% of cases had a high burden of chronic diseases (≥3 histopathological diagnoses per subject). Only 32% of cases had a clear psychiatric diagnosis. The low number of cases (71) and the absence of a control group precluded us from drawing more specific assumptions.Our findings support the idea that, in geriatric competent subjects, the proportion of subjects bearing a heavy burden of chronic diseases will impact the suicide rate more than psychiatric conditions even for elderly people living in an area where there is a strong culture against suicide.

During the last 30 years inflammatory bowel disease specialist nurses have become commonplace throughout the United Kingdom. These days they play a very significant role in the day-to-day management of patients with Crohn's disease and ulcerative colitis. They provide advice on the telephone, run out-patient clinics, administer biologic therapies and provide support to inpatients. However, there are no mandatory training programmes or required accreditation to specifically support these activities. As a result of these clinical roles, IBD nurses are now commonly involved in cases of alleged clinical negligence and questions arise to their independent practice and to whom they are directly responsible. This paper reviews these issues in some detail.

Cavernous haemangioma of the liver is a common benign vascular lesion, frequently asymptomatic and identified incidentally through imaging techniques. However, its identification during autopsy is uncommon. This report describes a 33-year-old male diagnosed with an incidental cavernous haemangioma of the liver identified during a post-mortem examination. The patient exhibited no previous history of liver disease or symptoms indicative of hepatic pathology. The gross examination identified an ill-defined, dark red, spongy lesion in the hepatic parenchyma. Histopathological analysis confirmed the diagnosis, revealing dilated vascular channels lined by endothelial cells, with no indications of malignancy. The clinical significance of hepatic haemangiomas is associated with potential complications, including rupture, haemorrhage and Kasabach-Merritt syndrome, even though most cases remain asymptomatic. This case emphasises the significance of identifying incidental hepatic haemangiomas in post-mortem examinations and recognising their benign characteristics to prevent unnecessary interventions during life.

BackgroundPerioperative vision loss following nonocular surgery is a rare but devastating complication. It typically occurs following spinal, cardiac, or head and neck procedures with ischaemic optic neuropathy being the primary cause. Despite increased understanding of potential risk factors, such as prolonged prone positioning, anaemia and hypotension, the legal implications remain underexplored. This study investigates malpractice litigation outcomes related to perioperative ischaemic optic neuropathy in the US.MethodsWe conducted a retrospective analysis of US malpractice cases involving perioperative ischaemic optic neuropathy following nonocular surgeries using the Westlaw Database. Cases included only those with jury verdicts and settlements. Relevant data, including patient demographics, surgery performed, defendant specialties, verdicts and monetary awards were collected and analysed.Results12 cases were included. Most affected patients were males (83.3%) with a mean age of 52 years. Spinal surgery (50%) was the most common procedure, and anaesthesiology (75%) was the most commonly litigated specialty. In 75% of cases, the defence was successful; however, in 16.7% of cases, the plaintiff won, with an average inflation-adjusted award of US$4.8 million (in 2024 dollars).ConclusionMalpractice claims related to perioperative ischaemic optic neuropathy predominantly favour defendants, suggesting that this complication is often viewed as unpreventable. However, proactive risk mitigation strategies, such as optimised positioning and thorough informed consent procedures, remain crucial to improving patient care and minimising litigation risks.

The Marriage and Civil Partnership (Minimum Age) Act 2022 made both registered and unregistered marriages of people under the age of 18 illegal in England and Wales. It came into force on 27 February 2023. This study looks at its impact on birth rates in South Asian communities in England. There has been a non-significant fall in such birth rates since the Act. However, the present system does not detect young South Asian women taken abroad to deliver their baby or the consequences of an early marriage abroad.

Suicidal cut throat injuries are uncommon; when they do occur they are usually caused by a knife or a razor. A hand saw as a means of suicide is most unusual and the resulting irregular and serrated wound margins, depth of injury. Associated anatomical damage must be analysed to distinguish a suicide from a homicide or accident. The psychological factors contributing to such an extreme choice of weapon should also be explored. We report a case of suicide by throat cutting using a hand saw along with a review of the forensic, and psychological extent of other such incidents.

Rabies is a vaccine-preventable zoonotic viral infection, but organophosphorus insecticide poisoning continues to be a toxicological emergency in India. An unusual co-occurrence is described in a 31-year old man who, following a puppy bite, ingested insecticide due to fear of rabies. Autopsy confirmed both poisoning and rabies presenting a rare diagnostic dilemma in forensic pathology.

Artificial intelligence (AI) in health care can assist with accurate detection of retinal diseases. However, UK Law does not currently explicitly provide for its regulation or liability for errors caused by an artificial intelligence system but those who use it may be held responsible when it malfunctions and causes harm. Who should be held liable when an AI image production or diagnostic system causes error? The system itself and those who produce it or the operators?