Legal medicine annual最新文献

1. The difficulty of correlating the microscopic appearances of the lungs in cases of stillbirth and early postnatal death with the results of hydrostatic tests in these cases is stressed. 2. Histologic criteria which depend on the presence of alveoli as evidence of extrauterine respiration are criticized. 3. The view is submitted that the alveolar pattern is the result of a normal developmental process occurring in utero, possibly accentuated by intrauterine fetal respiratory movements, but independent of extrauterine respiration. 4. The glandlike appearance of the lung which has been illustrated in standard textbooks as an example of unrespired fetal lung is probably seen only in relatively early embryos in whom the problem of respiration is unlikely to arise. 5. At or near term the alveolar pattern in the human fetus has developed, certainly in parts of the lung, to such a degree in utero that it cannot readily be distinguished from the pattern seen in the newly-born infant who has breathed for a short time in an extrauterine environment. 6. This view that the alveolar pattern is already fairly well developed at full-term makes for a more intelligible appreciation of the structural appearances seen in the immediately postnatal lung as well as of the physiology of respiration with the first extrauterine breath. 7. The views outlined for the development of the human lung in utero are completely corroborated by experimental studies on pig embryos, intraocular lung implants and the structure of sequestrated lung tissue unconnected with the respiratory tract. 8. Microscopic examination of the lungs may assist in determining fetal age. 9. The medicolegal significance of these observations is discussed.

Contamination of blood samples collected for alcohol analysis from swabbing with an ethanolic antiseptic is minimal (less than 0.6 mg/100 ml or 0.0006 percent ethanol) when routine clinical technique is followed. When technicians were told to be deliberately sloppy, considerable contamination (89 mg/100 ml or 0.09 percent ethanol) occurred. The incidence and extent of contamination from banked blood intended for transfusions are minimal. Two percent of the 1,450 samples analyzed contained alcohol. The average blood alcohol concentration was 26 mg/100 ml or 0.03 percent ethanol. One microliter of rubbing alcohol per milliliter of whole blood, or one-tenth of a drop of rubbing alcohol per milliliter of whole blood, increases the BAC 56.5 mg/100 ml (0.06 percent ethanol) and 67.5 mg/100 ml (0.07 percent ethanol), respectively.

The effect of PSRO on the practice of defensive medicine and the effect of the civil immunity provision on the numbers of malpractice suits may well be substantial. Cost savings in terms of control of overutilization and of the potential for patient injury engendered by that overutilization will ensue. While substantial, those effects will be small compared to the effect of PSRO on the present medical malpractice system. As a social system, malpractice has two positive purposes. It serves as a measure of quality control on outcomes of medical care, and it serves to compensate people for injuries received in medically related situations. How well it serves these purposes is unknown, but what few data exist indicate that it does not significantly enhance the quality of care nor provide an efficient method of compensation. It exists in theory because it is the final check and balance on physician practice--the only existing control on the outcomes of care. Until some system other than malpractice could be conceived which was at least as efficient in outcomes control, malpractice was destined to continue, and no other method of patient compensation could be considered seriously since the compensation and quality control aspects of malpractice were so inextricably bound. With the advent of PSRO, another means of outcomes control came into existence, and as PSRO becomes operational nationwide, that system will prove an efficient and effective system of control over the quality of outcomes of medical care. Within the environment of PSRO, malpractice as a system of outcomes control has little reason to exist, and its worth as a system of patient compensation can be reexamined. It is within the framework of PSRO that other systems of compensation of the injured patient can be considered and developed--systems hopefully more just and more efficient than malpractice. This is the greatest impact PSRO will have on malpractice. It is, of course, a long-term process, and one which will not produce immediate results. In fact, the role of PSRO in effecting a change in patient compensation may never be recognized directly. It is only within the existence of a working system controlling the quality of outcomes of medical care that the injustices of the malpractice system can be righted and alternatives to that system can be considered.