Forensic investigation of submersion deaths

Context: The diagnosis of the cause and the establishment of the manner of death in submersion cases are routine challenge for forensic pathologists as it presents considerable diagnostic difficulties. Objective: To concisely review the main questions during a submersion death investigation and to give the respective documented answers. Data sources: The search strategy included a literature search of PubMed, Medline and Google Scholar databases, as well as a review of the cited references by the identified studies and a hand search of relevant textbooks and reference works. Conclusions: A complete autopsy, histopathological examination and full toxicological screening are important to determine whether death indeed followed submersion in the water, or to see whether any natural disease or substance use have contributed or caused death. In ambiguous situations, the co-estimation of circumstantial evidence may be of invaluable importance toward the conclusion concerning the cause and the manner of death. The thorough forensic investigation of the submersion deaths not only serves the justice administration, but it also presents considerable benefits for the public health. © 2009 Blackwell Publishing Ltd

Health care provision in prisons: A review on European and international guidelines

Health care provision in prisons is an area of increasing international concern. The spectrum of health problems which prisoners may bring to prison is wide and in many cases prevalence is greater than in the general population. The profound knowledge of delicate issues such as medical confidentiality and informed consent of the patient, with special refer to infectious disease, hunger strike and prison research is necessary in the prison working environment. In the following paragraphs the European and International conventions and guidelines on the matter are discussed

Medical confidentiality: Legal and ethical aspects in Greece

Respect for confidentiality is firmly established in codes of ethics and law. Medical care and the patients' trust depend on the ability of the doctors to maintain confidentiality. Without a guarantee of confidentiality, many patients would want to avoid seeking medical assistance The principle of confidentiality, however, is not absolute and may be overridden by public interests. On some occasions (birth, death, infectious disease) there is a legal obligation on the part of the doctor to disclose but only to the appropriate authorities. Permissible disclosure can be granted by the patients' consent, for example, for the purpose of insurance they may wish to take out. Moreover, there are some ambivalent situations (such as criminal acts, or notification of sexual partner in case of a patient with AIDS) for which Greek law does not include relevant provisions, and the Codes of Medical Ethics do not offer clear guidelines. Therefore, the Greek doctor is called to estimate the situation and assume full responsibility for his decision. Finally, new considerations have arisen in the context of the recent advances in the field of telemedicine and electronic archiving. The paper discusses the current situation and legislation in Greece. © 2008 The Authors

Current aspects of penal surgical liability in Greece

The surgeon may face in every day practice issues that may render him liable. The legal liability usually emerges due to the negligence exhibited during the preoperative, the operative and the postoperative stage. The surgeon, as any doctor, isn't liable for the result, but he is responsible for the correct diagnosis and therapeutic treatment, always according to the principles of the Medical science and to the possibilities available to him in every specific case (facilities and time). The continuous education about the issues of his speciality, the adaptation of scientifically approved techniques, the correct monitoring of the patient, both preoperatively and postoperatively, and finally the good communication with the patient are necessary for the proper practice of Medicine; but also constitute the "shield" of the surgeon against any possible legal conflict. © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved

Ibogaine related sudden death: A case report

Ibogaine is a naturally occurring alkaloid derived from the roots of the rain forest shrub Tabernanthe iboga. Deaths have occurred temporarily related to the use of ibogaine. However, although not licensed as therapeutic drug, and despite evidence that ibogaine may disturb the rhythm of the heart, this alkaloid is currently used as an anti-addiction drug in alternative medicine for detoxification purposes. We report the case of a man who died suddenly 12-24 h after ibogaine use for alcohol detoxification treatment. In the autopsy liver cirrhosis and heavy fatty infiltration was found. The concentration of ibogaine was 2 mg/l. The potential risks of ibogaine use, especially for persons with pathological medical background, are discussed. © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved

Age- and region-related changes in the biomechanical properties and composition of the human ureter

The ureter has been largely overlooked heretofore in the study of the biomechanics of soft biological tissues, although there has been significant motivation to use its biomechanical properties as inputs to mathematical models of ureteral function. Herein, we used histological analysis for quantification of collagen contents and thickness/area of ureteral layers, with concomitant geometrical analysis of zero-stress and no-load states, and inflation/extension testing to biomechanically characterize with the Fung-type model the ureters from cadavers. The effects of age and gender on the regional distribution of those properties were examined. Tissue properties did not differ (p>0.05) between the left and right ureter. Regional heterogeneity was established that was profoundly age-related but seldom gender-related, based on the following evidence: 1) In younger subjects, the axial stress-circumferential strain curves of upper ureter were shifted to smaller stresses and model parameter a2 representing axial stiffness was smallest (p<0.05), i.e. upper ureter was the least stiff region axially; 2) upper ureter underwent axial stiffening with advanced age, evidenced by the increasing (p<0.05) parameter a2, and the stress-strain curves were uniformly exhibited along the ureter, evidenced by the non-varying (p>0.05) parameters C,a1,a2,anda4; 3) aging raised (p<0.05) the collagen content of upper ureter to favor a near-uniform regional distribution; 4) wall thickness increased with age, unlike the opening angle and residual strains, reflecting the thickening of outer (muscular) vs. inner (mucosal) layers in aged subjects, with significant differences (p<0.05) in some regions; and 5) gender affected little (p>0.05) the opening angle and morphometry of no-load and zero-stress states. © 2016 Elsevier Lt

Regional distribution of circumferential residual strains in the human aorta according to age and gender

The biomechanical response of the human aorta varies with axial location, but little is known about the respective variation of residual strains. Such data are available for common lab animals, but in the traditional opening angle measurement the aorta is considered as an ideal cylinder and average residual strains are measured, so that the spatial variations of local residual strains are not determined. The present study provides opening angle and residual strain data throughout the course and around the circumference of the aorta harvested during autopsy. Opening angle showed notable topographical variation; the highest value was at the top of aortic arch, declining abruptly toward the ascending aorta and to a near-constant value in the descending aorta, and rising in the abdominal aorta. The variation of curvature and of external but not internal residual stretch resembled that of opening angle. Extensive residual stress and wall thickness differences were evidenced among quadrants, with the more pre-stressed being also the thicker quadrants. Gender had overall minor effects, but aging led to increased parameters, occurring earlier in the distal aorta but at later stages becoming predominant proximally. Differences in caliber were pronounced in older subjects, unlike those in opening angle, residual stretches, and thickness that were striking in middle-aged subjects. By contrast, curvature decreased with aging in relation to the smaller percentwise opening angle differences. Detailed knowledge of the zero-stress/no-load geometry of the human aortic wall is critical for an in-depth understanding of aortic physiology, while providing the basis for comparison with disease. © 2016 Elsevier Lt

Variation of Axial Residual Strains along the Course and Circumference of Human Aorta Considering Age and Gender

Our understanding of aortic biomechanics is customarily limited by lack of information on the axial residual stretches of the vessel in both humans and experimental animals that would facilitate the identification of its actual zero-stress state. The aim of this study was thus to acquire hitherto unreported quantitative knowledge of axial opening angle and residual stretches in different segments and quadrants of the human aorta according to age and gender. Twenty-three aortas were harvested during autopsy from the aortic root to the iliac bifurcation and were divided into ≥12 segments and 4 quadrants. Morphometric measurements were taken in the excised/curled configuration of rectangular strips considered to be under zero-stress using image-analysis software to study the axial/circumferential variation of axial opening angle, internal/external residual stretch, and thickness of the aortic wall. The measured data demonstrated: (1) an axial opening angle peak at the arch branches, decreasing toward the ascending and to a near-constant value in the descending thoracic aorta, and increasing in the abdominal aorta; (2) the variation of residual stretches resembled that of opening angle, but axial differences in external residual stretch were more prominent; (3) wall thickness showed a progressive diminution along the vessel; (4) the highest opening angle/residual stretches were found in the inner quadrant and the lowest in the outer quadrant; (5) the anterior was the thinnest quadrant throughout the aorta; (6) age caused thickening but greatly reduced axial opening angle/residual stretches, without differences between males and females. © 2020 American Society of Mechanical Engineers (ASME). All rights reserved

Regional and age-dependent residual strains, curvature, and dimensions of the human ureter

The ureters are retroperitoneal structures controlling urine transport from the kidneys to the bladder. Because of the relative scarcity of data on the biomechanical properties of human ureter and the established importance of knowing these properties for understanding its physiology, we initiated biomechanical studies in cadaveric tissue. Herein, we report definite zero-stress/no-load geometrical characterization at 15 regions along the ureter of human cadavers aged 23–82 years, estimating the opening angle, circumferential residual strains, axial curvature, and dimensional parameters. Opening angle decreased along the proximal 25% of ureter, increased and reached a maximum near the mid-ureter, and then gradually decreased toward the vesicoureteral junction (young: p < 0.05; middle-aged: p < 0.05; old: p > 0.05; males: p < 0.05; females: p < 0.05). Similar were the regional distributions of residual strain at the interface between epithelium–lamina propria and muscle and of internal but not external residual strain. Wall thickness increased steadily with aging (p < 0.05 at few regions), while ureteral circumference did not (p > 0.05 at most regions) and opening angle decreased (p < 0.05 at several regions). Consistent with Fung’s stress-growth law, the muscle layer thickened with age unlike the epithelium–lamina propria that thinned (p < 0.05 at most regions for both thicknesses). Moderate-to-strong direct correlations of residual strain difference (= external – internal) with opening angle, wall thickness, and curvature were found in most ureters. The presented data will provide insight into the biomechanical response of ureter under zero/low-stress conditions and the relationship between ureteral remodeling and aging. Importantly, they may also be used to inform finite element models and computational studies simulating the ureter. © 2017, © IMechE 2017