Iranian Journal of Forensic Medicine
Year:2003 | Volume:9 | Issue:31|Papers Count:10

Background: The most prevalent and important forms of local trauma in legal medicine are injuries of head and spinal column. So, a coroner should be well aware of traumas neuropathology, since head injuries play an important role in deaths which are due to quarells, falls and traffic accidents.Methods: The present study had been performed on 216 cases of death due to head trauma from September 1999 to August 2000. This has been a prospective study and all cases were autopsied in legal medicine center to Tabriz to identify the cause of death.Results: The results are provided through macroscopic observations during the autopsies Epidemiologic surveys (including age, sex, season, and etiologic factors) are also carried out. All those who had died in hospitals were checked for secondary traumas and prognostic factors (e.g: blood pressure, respiration, pupil size, CFS leak, GCS and performed surgical operations).Conclusion: The results show that subdural hematoma was the most common extraaxial injury and brain's contusion the most common intraaxial injury, while the most common finding was linear fractures of the skull.

Background: Mortality due to poisoning differs from region to region. This study was set up to evaluate the distribution of poisonings and causes of death through clinical and autopsy results. Methods: 6941 poisoned patients, hospitalized in the Department of Poisoning Emergence, Noor Hospital, Isfahan in 1378-1380 were evaluated. 88 vases of death have been studied according to the data of Isfahan Forensic Medical Center. Results: The most common causes of the death were opiates (11.9%), Organophosphates (11.43%) and Paraquat (9.41%), but the highest FT1 (Fatal Toxicity Index=Death/exposure) were from cyanide (33.33%), paraquat (18.93%) and organophosphates (4.01%) poisoning. Death was related to product toxicity and severity of poisoning, specific mechanism of toxicity; and unknown treatment; while there might be a relationship between a fatal outcome and a delay between ingestion and medical support.Conclusion: Death of non-poisoned patients in the Poisoning Emergency Department (43.32%) necessitates the screening of the patients. Difference between initial and final diagnosis (55.65%) shows the necessity for increasing the accuracy of clinical diagnosis by the aid of toxicological laboratory.

Background: Domestic violence (DV) is the most prevalent form of violence against women with a lot of social, psychological and economic consequences. Therefore this research has been done to identify effects and causes of violence and also characteristics of victims. The results can be useful in identification of victimized women and incidence of this problem and also selection of the protective measures. Methods: this study was cross sectional and prospective that was performed on woman referred to legal medical center of Babol during one year (Feb-Apr 2001-2). Women with a history of domestic violence (DV) were considered as case group (183 women) and married women without a history of DV a evidence group (325 women). Data gathering was performed using questionnaires which were completed after interview a examination. Results: The prevalence of DV was 36% among those referred to our center. Detected injuries were mostly physical, while 13% of victims complained about being forced to have sexual inter course. Seventy- one percent of these women had psychosomtic symptoms of various kinds. The most common sites of injury were head and neck (22.3%) and extremities (21.6%). In most cases (54%) injuries were caused by beating, although a number of them (41%) were wounded (along with beating or only with wounds). Assessment of injuries revealed that in most cases of battery the result was bruising (42.4%) and in most cases of wounding abrasion or slight wounds has occurred (78.7%) the most common tools used in these cases were hard objects (89.6%). The most important underlying causes of DV were drug abuse (31.1%) and behavioral disorders (29%). Statistical tests revealed a meaningful correlation between individual, social and family characteristics of the two groups (case and evidence). Conclusion: Findings reveal a high prevalence of violence against women in Iran, compared with other countries. This study showed that most cases of violence occur in families in which the couple were between 20-40 years old, married for less than 10 years and had fewer children. Health care professionals should be able to identify at-risk women and use their skills to protect them.

Background: During recent years advancements in emergency management, have resulted in an increase in the number of tracheal intubation cases.Also considering various cases of pharyngeal and laryngeal injuries due to fatal pressure on the neck in criminal situations and artefactual hemorrhages in congestive deaths, differential diagnosis of injuries requires significant attention. The purpose of this, is differentiation and discrimination of injuries due to intubation due to Artefact. Methods: In this analytical descriptive study carried out at men's autopsy room in legal medicine organization, Tehran, one hundred intubated cases and one hundred non-intubated controls were investigated with determination of acute macroscopic injuries of mouth, pharynx and larynx due to emergency orotracheal intubation. Results: The most common indication for intubation was decreased consci ousness and loss of protective airway reflexes. Lips and mouth injures in 31% and pharyngeal and laryngeal injuries in 59% of intubated cases were detected, with hyoid bone fractures and thyroid cartilage fractures in 7% and 10% of cases respectively. Conclusion: The topographic difference of fracture sites in intubation cases compared to fatal pressure on the neck was statistically significant.

Background: Cosmetic and reconstructive septorhinoplasties have been increasing and are universally acknowledged as the most elegant but most difficult of all plastic surgical procedures. The inability to diagnose the possibilities and limitations inherent in each patient can result in some dangerous complications that may lead to legal malpractice lawsuits. Our objective was to evaluate demographic characteristics of claimants and to assess possible predictors including age of patients, place of surgeries and type of anaesthesia for developing complications that surgeons have been sued for.Methods: A retrospective case-series study was conducted at Forensic Medicine Service based in Tehran, Iran and included medical malpractice claims records field and referred to this center. Data were extracted from medicolegal records. Clinical, demographic and other predictor variables were gathered and then analyzed using SPSS software.Results: Of 120 cases studied, otolaryngologists were involved most commonly (90, %75). The mean age of claimants was 31.5 (±12.5) years. Lab data and clinical exams revealed underlying disease in 8 cases (%6.7). 46 cases (%38,3) had revisional surgery.Asymmetry was the most complication of surgery followed by breathing difficulty, dissatisfaction, death, septal perforation and decrease in subjective olfaction consecutively. No significant difference was seen in the frequency of complications between general and local anesthesia and also when comparing with place of surgery. 12 Lawsuits (%10) were due to surgeries that resulted in death. 35 Surgeons (%29) were eventually acquitted.Conclusion: This study has disclosed some potential complications of nasal surgery. Septorhinoplasty should not be undertaken lightly, training and experience are essential. To minimize the risk of malpractices claims, surgeons who perform elective cosmetic surgery should select patients who meet selection criteria. Patients seeking elective cosmetic surgery are already unhappy with their appearance. Unrealistic expectations or psychological problems may also lead to unhappiness with the results, as well as the surgeon. When surgeons fail to recognize these issues, they may become trapped in a situation that leads to litigation. Further comprehensive studies are needed to validate these results and to implement the study.

Background: while Iran has one of the youngest populations of the world, advancements in health care and economic development have increased life expectancy.The share of the elderly in our populations is around 6.5% and they require a great deal of care and attention, but factors like changing role of family, existing erises and psychological pressures of modem life, together with the family's ignorance of its roles and duties will couse elderly neglect. A quasi experimental research to assess the effect of family counseling programs of prevention of elderly neglect of woman residing in Tehran was performed. Methods: Available samples (30 families) were used, and data relating to pre and post-counseling were gathered through observation and interview by guestionnaires and check-lists.Results: T-test and wilcoxon test showed that there is a significant (meaning ful) difference in mean of scores of family and the old, apparent indicators of neglect and its real amount (0.001), which means family counseling program has prevented elderly neglect significantly. The results revealed a meaningful correlation between the elderly's bodily problems. Level of education and family income and neglect of the elder Namely, with increase in bodily problems, decreasein education and income, elderly neglect increased.Conclusion: on the basis of these results, we suggest that family counseling be applied as a method in prevention of elderly neglect.

Volkmann's contracture ischemia occure due to and increase in internal pressure of closed compartments of extremities and leaving the condition untreated.The most common site of occurrence of compartment syndrome is the flexor side of upper extremities, with simultaneous engagement of extensor compartment. In general, isolated engagement of forearm's extensor and pronator teres muscle is rarely seen.The patients was 12 years old boy from Lorestan with a history of snake bite dating back to five years ago, and his examination revealed on engagement of right upper extremity as a contracture of extensors of the forearm and pronator teres.Snake bite is a rare cause of compartment syndrome. Many authors do not believe in occurrence of compartment syndrome following a snake bite. In this patient, because of presence of Volkmann's syndrome. It seems that the belief does not hold sway and there is a possibility of contracture following compartment syndrome in similar cases and it should be noted.Therefore, in presence of signs of ischemia or compartment syndrome following snake bite, fasciotomy of the exteremity should be done along with debridement of the site of bite. If signs of compartment syndrome cannot be examined, due to severe pain and swelling, the compartment's pressure should be measured.

Noise-induced hearing loss is one of the most common hearing problems in adult population and includes thirty percent of hearing loss etiologic in this group. This disease causes serious physical and psychosocial disabilities that impose a severe financial burden on health and social services. Thorough occupational history along with classic audiometric findings suggests this diagnosis with high probability. Because of certain difficulties such as long duration between previous noise exposure and patient's claim, lack of precise history of intensity and duration of noise exposure, history of co-exposure to non-occupational sources of noise in the off-the-job activities and various atypical configurations in audiogram, the diagnosis of this disease would be troublesome. The goal of this article is to assist the diagnosis of noise-induced hearing loss in medico- legal settings.