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Forensic aspects of communication with the patient and bereaved persons in out-of-hospital practice. 在院外实践中与病人和死者家属沟通的法医方面。
Q4 Medicine Pub Date : 2019-01-01
Kaniok Radek, Novomeský František, Veselá Kanioková Petra

It is not easy to characterize a problem patient or bereaved relatives because identifying a patient or his bereaved family as a “problem” is not considered quite ethical. The approached emergency medical service employees and coroner service physicians were asked to complete a specific targeted anonymous survey. 100 % of survey questionnaires were returned. The questionnaire with a request for filling and returning was submitted to forty employees working full-time, twenty of whom were physicians, ten paramedics and ten lower-level healthcare professionals. The questionnaire comprised ten questions aimed at obtaining clear answers to questions about personal experience with problem patients, specifically aggressive patients, and more specifically whether the health care professionals (HCP) has ever felt immediately threatened by a patient in their work, whether they were exposed to verbal or even physical attack in the context of the patients basic diagnosis established during pre-hospital care. Seventy-five percent of respondents answered Yes to Question No. 5: “Have you ever felt threatened by a patient or bereaved relative in your work?” Eighty percent of respondents answered Yes to Question No. 6: “Have you ever been exposed to a verbal attack by a patient or bereaved relative?” Seventy-five percent of them answered Yes to Question No. 7: “Have you ever been exposed to a physical attack by a patient?” The rate of cases in which emergency medical service employees are exposed to verbal or physical attacks is high. The primary experience hypothesis that this happens has been proven as well as the fact that it is a highly topical and therefore unresolved issue that threatens the whole society with its social implications.

要确定问题患者或其家属的特征并不容易,因为确定患者或其家属是一个问题。被认为是不太道德的。被接触的紧急医疗服务人员和验尸服务医生被要求完成一项特定的有针对性的匿名调查。问卷回收率为100%。要求填写和返回的调查问卷提交给40名全职工作的雇员,其中20名是医生,10名护理人员和10名低级保健专业人员。问卷包括10个问题,旨在明确回答以下问题:问题患者的个人经历,特别是攻击性患者,更具体地说,卫生保健专业人员(HCP)是否在工作中立即感受到患者的威胁,他们是否在院前护理期间建立的患者基本诊断背景下遭受口头甚至身体攻击。在第5个问题中,75%的受访者回答“是”;在工作中,你是否曾感受到病人或失去亲人的威胁?在第6个问题中,80%的受访者回答“是”;你是否曾遭受过病人或失去亲人的亲属的言语攻击?在第7个问题中,75%的人回答“是”:“你曾经遭受过病人的身体攻击吗?”紧急医疗服务人员遭受言语或身体攻击的比率很高。发生这种情况的主要经验假设已被证明,以及这是一个高度热门的,因此未解决的问题,威胁着整个社会及其社会影响的事实。
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引用次数: 0
Medicolegal implication of an autopsy case of methidathion ingestion. 甲硫磷摄入的尸检案例的医学法律意义。
Q4 Medicine Pub Date : 2019-01-01
Tanaka Naoko, Kinoshita Hiroshi, Kumihashi Mitsuru, Jamal Mostofa, Ito Asuka, Tsutsui Kunihiko, Kimura Shoji, Ameno Kiyoshi

We present an autopsy case involving ingestion of methidathion, an organothiophosphate pesticide. A headspace gas chromatography mass spectrometry system was used for screening of volatile compounds. Subsequent toxicological analysis was performed using liquid chromatography tandem mass spectrometry. Xylene and ethylbenzene were detected in stomach contents. We also identified methidathion at concentrations of 3.07 and 2240 µg/ml in femoral venous blood and stomach contents, respectively. We concluded that the victim ingested methidathion insecticide, with an estimated dose of at least 9.2 g.

我们提出的尸检案件涉及摄入甲胺磷,一种有机硫磷农药。采用顶空气相色谱-质谱法对挥发性化合物进行了筛选。随后采用液相色谱串联质谱法进行毒理学分析。胃内容物中检出二甲苯和乙苯。我们还在股静液血和胃内容物中分别鉴定出浓度为3.07和2240µg/ml的甲基硫磷。我们的结论是,受害人摄入了估计剂量至少为9.2克的杀虫硫磷杀虫剂。
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引用次数: 0
Alcohol abuse in road traffic: medical-legal aspects. 道路交通中的酒精滥用:医疗-法律问题。
Q4 Medicine Pub Date : 2018-01-01
Petr Štiak, Ľubomír Straka

Alcohol-affected road users - pedestrians or drivers are a significant risk factor for road accidents and injuries. Therefore, the issue of alcohol-related traffic accidents is logically a subject of great attention. However, the statistics results of the General Prosecutor's Office of the Slovak Republic and of the Police Force of the Slovak Republic clearly confirm the fact that in the Slovak Republic the above-mentioned problem of the whole society is not sufficiently eliminated. The legislation implemented since 2011 should therefore lead to more substantial and effective prevention in this area. From the point of view of the current knowledge from the Forensic Medicine Department, the current legislative regulation of the Slovak Republic is still insufficient and will require some changes. It can be assumed that the issue of controlling the influence of alcohol on road users will be a subject of harmonization throughout the European area. The aim of this thesis is to analyse individual aspects of the present state and their epicritical evaluation. Keywords: alcohol - driver - prevention - forensic medicine - legislation.

受酒精影响的道路使用者——行人或司机——是道路事故和伤害的重要危险因素。因此,与酒精有关的交通事故问题自然是一个备受关注的话题。但是,斯洛伐克共和国总检察长办公室和斯洛伐克共和国警察部队的统计结果清楚地证实,在斯洛伐克共和国,整个社会的上述问题没有得到充分消除。因此,自2011年以来实施的立法应在这一领域进行更实质性和更有效的预防。从法医学司目前的知识来看,斯洛伐克共和国目前的立法条例仍然不足,需要进行一些修改。可以假定,控制酒精对道路使用者的影响的问题将是整个欧洲地区统一的一个主题。本文的目的是分析现状的各个方面及其批判评价。关键词:酒后驾车;预防;法医学;
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引用次数: 0
Redistribution of acute traumatic infratentorial subdural hematoma to the spinal subdural space. 急性外伤性幕下硬膜下血肿在脊髓硬膜下间隙的再分布。
Q4 Medicine Pub Date : 2018-01-01
Silvia Farkašová Iannaccone, Alžbeta Ginelliová, Ivana Šantová, Marián Šanta, Daniel Farkaš, Radoslav Morochovič, Lucia Fröhlichová, Vladimír Balik

Spinal subdural hematoma is a rare and potentionally life-threatening condition associated with trauma and other pathological conditions. In this paper we report the autopsy findings of a 64 year old male who was repeatedly hospitalized with traumatic head injuries in the past. In this case spinal subdural hematoma was diagnosed post-mortem and later comfirmed by ante-mortem CT scan revaluation. Keywords: intracranial subdural hematoma - recurrent spinal subdural hematoma - diffuse axonal injury - autopsy findings.

脊髓硬膜下血肿是一种罕见且可能危及生命的疾病,与创伤和其他病理状况有关。在这篇论文中,我们报告了一名64岁男性的尸检结果,他在过去多次住院治疗创伤性头部损伤。在这个病例中,脊髓硬膜下血肿是在死后被诊断出来的,后来通过死前CT扫描重新评估得到了证实。关键词:颅内硬膜下血肿-复发性脊髓硬膜下血肿-弥漫性轴索损伤-尸检结果。
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引用次数: 0
Blood is thicker than water: Physical limitations of bloodstain pattern analysis. 血浓于水:血迹模式分析的物理限制。
Q4 Medicine Pub Date : 2018-01-01
Šrámek Jaromír

Scientific bloodstain pattern analysis was appeared at the end of the 19th century in Kraków. Nowadays, bloodstain pattern analysis is the forensic science involving analysis of blood traces on the crime scene. One topic is an estimation of the point of origin of given blood spatter. The processes behind the formation of the blood spatter are quite complicated, some simplifications are necessary. For example, the true trajectory of the blood drop is rather the ballistic curve than the line, though the line is often used as a sufficient model of the trajectory. Next, the blood is a non-Newtonian complex fluid, it differs from common fluids like water. Moreover, qualities of the surface are also involved in the formation of the final spatter. Some of these properties of blood must be neglected in order to make the modeling of the formation of the spatter possible. The crucial question is how to determine the angle of impact of the blood drop. The widely used method is the ellipse fitting method which is based on the assumption that the blood drop is ball-shaped and the spatter is chiefly the ellipse-shaped imprint of the falling drop. Other methods are using rather in experiments than in practice. Unfortunately, all these simplifications lead to the increasing uncertainty and, therefore, the point of origin is rather estimated than determined. Selection of an appropriate model of the behavior of the blood drop and estimation of uncertainty of obtained results should be based on related knowledge close to the physics of blood. Keywords: bloodstain pattern analysis - biomechanics.

科学的血迹模式分析出现在19世纪末的Kraków。目前,血迹模式分析是对犯罪现场的血迹进行分析的法医学。其中一个主题是对给定血液飞溅的起源点的估计。血溅形成的过程相当复杂,有必要进行一些简化。例如,血滴的真实轨迹是弹道曲线而不是直线,尽管直线经常被用作轨迹的充分模型。其次,血液是一种非牛顿复杂流体,它不同于普通的液体,比如水。此外,表面的质量也与最终飞溅的形成有关。为了对飞溅的形成进行建模,必须忽略血液的某些特性。关键的问题是如何确定血滴撞击的角度。目前广泛使用的方法是椭圆拟合法,该方法假设血滴呈球形,而飞溅物主要是血滴的椭圆形印记。其他方法只是在实验中使用,而不是在实践中使用。不幸的是,所有这些简化导致了越来越多的不确定性,因此,原点是估计而不是确定的。选择合适的血滴行为模型和估计所得结果的不确定度应基于接近血液物理的相关知识。关键词:血迹形态分析;生物力学;
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引用次数: 0
[Deaths of people in the mountainous territory of High Tatras]. [高塔特拉山区的死亡人数]。
Q4 Medicine Pub Date : 2018-01-01
Ján Bajaj, Lukáš Hamerlik, Stanislav Niezňanský, Anton Gavel, Henryk Zajac

Authors Poprad, since the establishment of the Department of Forensic Medicine in Poprad in 1991 up to now. As mountainous environment is considered an area above the border of Tatranská magistrálna (a tourist footpath which leads across the High Tatras and partially Western Tatras). The file discusses the causes and mechanisms of death and their causal relationships, shows the nationality, age, gender or place of death of deceased people, amounts of deaths in the months of year and also in the days of week. Some results are shown in the graphs, the percentage results are described in a text. Valuable and complete results were reached only in cases with describe statistically a group of people who died in the mountainous environment of the High and Belianske Tatras for the last 25 years and who were dissected on the Department of Forensic Medicine in complete documentation (and also after autopsy, not every case of death was autopsied). At the same time, the authors describe the system of cooperation between the Department of Forensic medicine and Pathological Anatomy of Health care surveillance Poprad with Mountain rescue components and the Police force of Slovak Republic, operating in the territory of the High and Belianske Tatras. These components help us to gain information about the case, which are not usually known during the first inspection of dead body in a mortuary or at the moment of an autopsy (hikers and climbers are often alone in the mountains, so their accidents are without witnesses).

作者波普拉德,自1991年在波普拉德成立法医学系至今。由于山区环境被认为是在tatransk magistrálna(一条穿越高塔特拉和部分西塔特拉的旅游步道)边界之上的区域。该档案讨论了死亡的原因和机制及其因果关系,显示了死者的国籍、年龄、性别或死亡地点,以及一年中的几个月和一周中的几天的死亡人数。部分结果用图表显示,百分比结果用文字说明。只有在统计上描述了过去25年里在高地和Belianske Tatras山区环境中死亡的一组人的情况下,才得出了有价值和完整的结果,法医部门对这些人进行了完整的解剖(也进行了尸检,但并非所有死亡病例都进行了尸检)。同时,提交人介绍了在高地和别良斯克塔特拉斯地区开展活动的法医和卫生保健监督病理解剖处与山地救援部门和斯洛伐克共和国警察部队之间的合作系统。这些组成部分帮助我们获得有关案件的信息,这些信息通常在太平间第一次检查尸体或在尸检时是不知道的(徒步旅行者和登山者经常独自一人在山上,所以他们的事故没有证人)。
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引用次数: 0
[Applicability of non-invasive imaging methods in forensic medicine and forensic anthropology in particular]. [非侵入性成像方法在法医学和法医人类学中的适用性]。
Q4 Medicine Pub Date : 2018-01-01
Mária Marcinková, Ľubomír Straka, František Novomeský, Martin Janík, František Štuller, Jozef Krajčovič

Massive progress in developing even more precise imaging modalities influenced all medical branches including the forensic medicine. In forensic anthropology, an inevitable part of forensic medicine itself, the use of all imaging modalities becomes even more important. Despite of acquiring more accurate informations about the deceased, all of them can be used in the process of identification and/or age estimation. X - ray imaging is most commonly used in detecting foreign bodies or various pathological changes of the deceased. Computed tomography, on the other hand, can be very helpful in the process of identification, whereas outcomes of this examination can be used for virtual reconstruction of living objects. Magnetic resonance imaging offers new opportunities in detecting cardiovascular pathological processes or develompental anomalies. Ultrasonography provides promising results in age estimation of living subjects without excessive doses of radiation. Processing the latest information sources available, authors introduce the application examples of X - ray imaging, computed tomography, magnetic resonance imaging and ultrasonography in everyday forensic medicine routine, with particular focusing on forensic anthropology.

在发展更精确的成像模式方面取得的巨大进展影响了包括法医学在内的所有医学分支。在法医人类学中,所有成像方式的使用变得更加重要,这是法医学本身不可避免的一部分。尽管获得了关于死者的更准确的信息,但所有这些信息都可以用于身份识别和/或年龄估计。X射线成像最常用于检测异物或死者的各种病理变化。另一方面,计算机断层扫描在识别过程中非常有帮助,而这种检查的结果可以用于活体物体的虚拟重建。磁共振成像为检测心血管病理过程或发育异常提供了新的机会。在没有过量辐射的情况下,超声检查对活着的人的年龄估计提供了很好的结果。作者整理了现有的最新信息来源,介绍了X射线成像、计算机断层扫描、磁共振成像和超声成像在法医日常工作中的应用实例,重点介绍了法医人类学。
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引用次数: 0
[Methodology of injury compensation and Government Regulation of injury compensation in reflection in the Constitutional Court decision]. [从宪法法院判决书中反映的伤害赔偿方法和政府对伤害赔偿的规制]。
Q4 Medicine Pub Date : 2017-01-01
Roman Žďárek

After the new Civil Code had come into force, the Compensation Statute lost the efficiency. The injury compensation should not have been provided according medical report with respect to the Compensation Statute but according decency basis. So the Highest Court has accepted the Methodology of compensation. The article deals with the first reflection of the Methodology in the judicature of the Constitutional Court as well as the opinion of the Constitutional Court of the Government Statute which regulates the injury compensation in labour law. The Metodology of compensation is based on the ICF (International Classification of Functioning, Disability and Health), while the Compensation Statute was based on the etiology principe. ICF is a classification of health and health-related domains. As the functioning and disability of an individual occurs in a context, ICF also includes a list of environmental factors. ICF is the WHO framework for measuring health and disability at both individual and population levels.

新民法典实施后,《赔偿规约》失去了原有的效力。根据《赔偿规约》,不应根据医疗报告提供伤害赔偿,而应根据体面基础提供伤害赔偿。因此,最高法院接受了赔偿方法。这条论述了该方法在宪法法院司法中的第一个反映,以及宪法法院对《政府规约》的意见,该规约规定了劳动法中的伤害赔偿。赔偿方法以《国际功能、残疾和健康分类》为基础,而《赔偿规约》则以病因原则为基础。ICF是健康和健康相关领域的分类。由于个体的功能和残疾发生在特定的环境中,ICF还包括一系列环境因素。ICF是卫生组织在个人和人口两级衡量健康和残疾的框架。
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引用次数: 0
[Injuries associated with cardiopulmonary resuscitation in non-survivors after out-of-hospital cardiac arrest (autopsy study)]. [院外心脏骤停后非幸存者心肺复苏相关损伤(尸检研究)]。
Q4 Medicine Pub Date : 2017-01-01
Lucia Ihnát Rudinská, Petr Hejna, Margita Smatanová, Peter Ihnát, Igor Dvořáček

The aim of the present study is to investigate incidence and seriousness of CPR-associated injuries on a cohort of CPR non-survivors after out-of-hospital cardiac arrest in the Moravian-Silesian region. In total, 80 persons were included in the study within the study period (2012 - 2015). CPR-associated injuries were identified in 75 (93.7 %) persons, multiple injuries were found in 73 persons. Spectrum of identified injuries covered skin injuries of the upper half of the body, head and neck injuries, rare abdominal injuries and very frequent thorax injuries. Sternal fractures were found in 53 (63.3 %) persons. Rib fractures were identified in 59 (73.0 %) persons; rib fractures were usually multiple (mean number of broken ribs was 7.6 per person). Intra-thoracic injuries were diagnosed in 33 (41.2 %) persons - findings of lung contusions and lacerations, transmural heart contusions, hemothorax and hemopericard. The vast majority of identified intra-thoracic injuries were considered clinically relevant (provided the fact that return of spontaneous circulation had been achieved). Intraabdominal injuries (liver and spleen injuries) were identified in 15 (18.7 %) of persons. Vast majority of these injuries was clinically irrelevant. We have found clinically serious injuries (spleen rupture and liver dilacerations) in 3 (3.7 %) persons. Outcomes of our study suggest that CPR-associated injuries are very common, usually multiple, and in some cases they might be even potentially lethal (if return of spontaneous circulation is achieved).Key words: cardiopulmonary resuscitation - cardiac arrest - injuries - autopsy study - sternal and rib fractures.

本研究的目的是调查摩拉维亚-西里西亚地区院外心脏骤停后CPR非幸存者队列中CPR相关损伤的发生率和严重程度。在研究期间(2012 - 2015),共有80人被纳入研究。75例(93.7%)患者出现心肺复苏相关损伤,73例患者出现多发损伤。已确定的损伤范围包括上半身皮肤损伤、头部和颈部损伤、罕见的腹部损伤和非常常见的胸部损伤。胸骨骨折53例(63.3%)。肋骨骨折59例(73.0%);肋骨骨折通常为多处(平均每人断裂肋骨7.6根)。33人(41.2%)被诊断为胸内损伤,主要表现为肺挫伤和撕裂伤、经壁心脏挫伤、胸血和包皮血。绝大多数确定的胸内损伤被认为是临床相关的(前提是已经实现了自发循环的恢复)。腹腔内损伤(肝和脾损伤)15例(18.7%)。这些损伤绝大多数与临床无关。我们发现临床上严重损伤(脾破裂和肝扩张)3人(3.7%)。我们的研究结果表明,心肺复苏相关的损伤是非常常见的,通常是多重的,在某些情况下,它们甚至可能是致命的(如果实现了自然循环的恢复)。关键词:心肺复苏-心脏骤停-损伤-尸检研究-胸骨和肋骨骨折
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引用次数: 0
An autopsy case of death by combined use of benzodiazepines and diphenidine. 苯二氮卓类药物与苯苯苯胺联合使用致死的尸检病例。
Q4 Medicine Pub Date : 2017-01-01
Hiroshi Kinoshita, Naoko Tanaka, Ayaka Takakura, Hiroko Abe, Mitsuru Kumihashi, Takayuki Shibayama, Mostofa Jamal, Asuka Ito, Kunihiko Tsutsui, Shoji Kimura, Hirotaro Iwase, Kiyoshi Ameno

We present an autopsy case involving benzodiazepines and diphenidine. Quantitative toxicological analysis showed concentrations of 7-aminoflunitrazepam (a flunitrazepam metabolite), 7-aminonimetazepam (a nimetazepam metabolite), chlorpheniramine and diphenidine in femoral blood of 0.086 µg/ml, 0.027 µg/ml, 0.066 µg/ml, and 0.073 µg/ml, respectively. Death was attributed to combined toxicity due to the influence of multiple drug interactions.

我们提出了一个涉及苯二氮卓类药物和苯苯苯胺的尸检病例。定量毒理学分析显示,7-氨氟硝西泮(氟硝西泮代谢物)、7-氨硝美西泮(尼美西泮代谢物)、氯苯那敏和苯苯定的血药浓度分别为0.086µg/ml、0.027µg/ml、0.066µg/ml和0.073µg/ml。由于多种药物相互作用的影响,死亡归因于联合毒性。
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引用次数: 0
期刊
Soudni Lekarstvi
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