A medico-legal definition of femicide

Femicide refers to the extreme form of violence against someone belonging to the female gender, i.e. the killing of a woman. Research shows that, to date, gender-based violence remains largely a hidden phenomenon with prevalence often being underestimated by official statistics and data missing in numerous countries. It can be argued that the under-reporting may be suggestive of a legislative gap that needs addressing.This work aims to reach a shared medico-legal definition of femicide stemming from a comprehensive review of the current legislation of countries around the world. In addition, it appraises forensic pathology studies focusing on the murder of women as well as the most relevant documents published by prominent international organizations fighting violence against women. Review of the literature shows a scarcity of national legislations concerning specifically femicide, despite the attention given to this phenomenon by international organizations fighting violence against women.Additionally, a non-homogeneous framing of the term femicide arises from the forensic pathology literature and national laws. Starting from one of the funding principle of medical ethics – autonomy – authors propose to define femicide as a murder perpetrated because of a failure to recognize the victim’s right to self-determination.This definition would give the forensic pathologist a central role in identifying femicide cases among the murders of women. A shared forensic approach is needed, ideally employing standardized methodology to compare international data and to standardize scientific research in the field.     

Analysis and comparison of domestic femicide cases in the cities of Diyarbakir & Tekirdag,Turkey: A preliminary study

Court decision files from 2007 to 2012 were examined retrospectively in the Criminal High Courts of Diyarbakir and Tekirdag to analyse and compare domestic femicides in Diyarbakir and Tekirdag, Turkey, according to different fundamental characteristics. In total, 58 assailants were convicted of 50 femicides during this period. There were no so-called ‘honour killings’ in Tekirdag, while 16 (37.2%) of the homicides were honour killings in Diyarbakir. Policies to prevent violence against women, extending the means of access to post-violence services and reinforcing the law, policies and action plans to end this type of violence could be effective in decreasing cases of domestic femicide.     

Menstrual cycle and thermoregulation during exercise in the heat: A systematic review and meta-analysis

Research conducted on exercise in the heat has been largely conducted in males, leaving women understudied. Of research including women, results are inconsistent on the impact of menstrual cycle phase on thermoregulation.ObjectivesThe purpose of this systematic review is to quantify published investigations in thermal physiology that include menstrual cycle comparisons and assess aggregate data of investigations that include menstrual cycle variation and aerobic exercise in the heat.Methods367 research articles were identified via systematic review and inclusion criteria and yielded 9 papers included in this analysis for a total number of 83 research subjects. Effect size estimates (Hedge's g) were utilized for initial (pre-exercise) and post-exercise internal body temperature (rectal or esophageal, T_int), sweat rate, mean skin temperature, and exercise heart rate.ResultsPooled effect size showed significantly greater initial T_int (1.231 ± 0.186, p < 0.01) and post-exercise T_int (0.455 ± 0.153, p < 0.01) in the luteal compared to follicular phases. No significant differences were present in mean skin temperature, sweat rate, or exercise heart rate across menstrual phases in analyses of aggregate data.ConclusionsThe limited available data suggest that observed increases in initial T_int in the luteal phase are maintained throughout and post-exercise without an observed impact in sweat rate or mean skin temperature.     

Primary sacral bone tumours in children (report of 16 cases with a short literature review)

16 cases of primary sacral bone tumours in children are reported. These include 13 patients with Ewing's sarcoma and 3 with very rare primary sacral bone tumours in childhood--chordoma, haemangiopericytoma and osteoblastoma. All sacral bone tumours, with the exception of Ewing's sarcoma are very rare in childhood. The possibility of a sacral tumour should be considered in a child with radiculopathy. CT and MR make the diagnosis of primary sacral bone tumours much easier with the added possibility of recognition of the true nature of the lesion in many instances. Reports of primary sacral bone tumours in children are scarce. Most of the patients are incorporated in adult series which do not specify the age of the child and the site of the tumour. The purpose of this paper is to describe 16 children with primary sacral bone tumours.     

Neck vascular lesions in hanging cases: A literature review

The aim of this review was to investigate the types and rates of vascular lesions occurring in cases of completed hanging and near-hanging, defined in literature.In the literature to date, 6 specific types of vascular injuries have been defined in cases of death as a result of hanging. These are Amussat's sign, Etienne Martin's sign, Dominguez-Paez sign, Friedberg-Lesser sign, Ziemke-Otto's sign, and Lupascu sign.As a result of this study, it was determined that the most defined finding was the Amussat sign, and it was concluded that the other findings were not sufficiently recognized.Likewise, considering that the proportional differences are due to the differences in the rates of autopsy practice and autopsy protocols between countries, it can be suggested that international joint autopsy protocols should be developed at the meetings in which national professional associations participate.     

Diverticula of the male urethra: A review of 61 cases

Sixty-one cases of diverticulum of the male urethra were reviewed. This group included 10 patients with congenital and 51 with acquired diverticula. The etiology of the acquired variety, the radiological findings, and the frequency of appearance in both congenital and acquired diverticula of the urethra during a 30-year period are described.     

Chemical submission to commit robbery: A series of involuntary intoxications with flunitrazepam in Asian travellers in Brussels

Between January 17, 2003 and August 29, 2003, the Emergency Department admitted a patient who had been surreptitiously intoxicated and robbed of his valuables every Friday. The first cases were considered anecdotal, but criminal activity was rapidly suspected. The cohort includes 16 male Asian patients aged 28–50 years. All the victims had just arrived in Brussels through one of the main rail station of the town and were admitted via the emergency ambulance service from different locations in the centre of Brussels around the CHU Saint-Pierre Hospital. Haemodynamic parameters upon admission were within normal limits. The Glasgow Coma Scale was equal or higher than 9/15 in 14 of the 16 victims. Toxicology screening obtained in 12 patients revealed the presence of flunitrazepam, which was further quantified at levels ranging from 21 to 75 μg/l. One of the Japanese patients, who returned to Belgium afterwards for professional reasons, was approached by the police and accepted to press charges. This allowed the police to investigate and send undercover agents to the railway station on Friday afternoons and evenings. They found a person who was offering welcome cookies to Asian travellers. He arrived from Amsterdam and returned once his crime was committed.Flunitrazepam is well known as a rape drug. We report a series of victims in whom flunitrazepam was used to facilitate robbery.     

The detection of picoplankton 16S rDNA in cases of drowning

Picoplankton belonging to theSynechococcus genus in cyanobacteria (approximately 1 μm in size) are found ubiquitously in Lake Biwa, Japan. However, they could not be morphologically discriminated from other bacteria by microscopy. In this study we attempted to use picoplankton for the diagnosis of drowning by PCR analysis of the 16S ribosomal DNA (rDNA). We designed primers complementary to the variable regions of 16S rDNA of the picoplankton we had sequenced. A comparison was made of the PCR products from the three picoplanktons, five other cyanobacteria,Melosira (diatom),Staurastrum (green alga), bacteria from Lake Baikal, and humans. The picogram order of template DNA from picoplankton was specifically amplified by the primers. When the template of picoplankton was mixed with human lung tissue, at least 10 ng of template DNA was needed to obtain a PCR product. The isolation of the picoplankton from human lung tissue increased the sensitivity of PCR more than a hundred-fold. The specific PCR products of the picoplankton were obtained from formalin-fixed drowning tissue. Molecular biological diagnosis of drowning was successful using picoplankton 16S rDNA.     

Rhabdomyolysis in adolescent athletes: review of cases

Rhabdomyolysis is a syndrome characterized by muscle pain, weakness and myoglobinuria and ranges in severity from asymptomatic to life threatening with acute kidney failure. While a common condition in adult populations, it is understudied in pediatrics and the majority of adolescent cases are likely exercise-induced, caused by strenuous exercise in athletes. Recently, in our pediatric sports medicine practice, we have seen numerous cases of late adolescent high school athletes who present with severe muscle pain and were found to have elevated creatine kinase levels. The cases review potential contributing factors including characteristics of the workout, use of supplements, caffeine, medication, and metabolic or genetic predisposition. Treatment for exercised-induced rhabdomyolysis rarely requires more than rehydration. Return to play should be progressive, individualized, and include acclimatization and monitoring of hydration status, though guidelines require further review.     

泡状棘球蚴病16例临床病理学及免疫组化观察

目的:探讨泡状棘球蚴病临床病理学及免疫组化特征。方法:对16例泡状棘球蚴病变组织切片进行CD20、CD3、CD45RA、CD45RO、CD5染色,部分病例做了EMA、CD68、CK标记。结果:泡状棘球蚴病见于肝、脑、肺、胰腺和淋巴结等器官,免疫组化结果提示病变内散在浸润淋巴细胞中有T细胞和B细胞,泡球囊肿内生发上皮与角质膜不表达CK和EMA,增生的组织细胞表达CD68和EMA。结论:泡状棘球蚴病诊断依赖病理活检,术前穿刺活检或术中冰冻切片检查是行之有效的诊断方法。消灭传染源,切断传播途径综合防治该病。     

Tramadol deaths in Northern Ireland: A review of cases from 1996 to 2012

In the UK tramadol is a frequently prescribed opioid analgesic which is becoming increasingly popular as a drug of misuse. Its use varies worldwide and in the last decade it has been upgraded to a controlled substance in several countries, due to an increased number of deaths associated with its use.A review of all deaths associated with tramadol in Northern Ireland was performed and this highlighted 127 cases from 1996 to the end of 2012. A 10% increase in deaths due to tramadol was noted. In 2001 tramadol deaths represented 9% of all drug misuse deaths rising to 40% in 2011. The majority of the deaths occurred in males (62%), with a median age of 41 years, living in the Belfast city area (36%). Tramadol fatalities were found in combination with other drugs/medicines (49%), alcohol (36%) or alone (23%). Most of those who died did not reach hospital, with only 2% presenting with multi-organ or acute liver failure. In just over half of the deaths tramadol had not been prescribed by a medical practitioner (53%). Depression, addiction and seizures were recognised risk factors.An increase in awareness of tramadol toxicity is needed amongst the public and doctors.     

The lethal paraphiliac syndrome: accidental autoerotic deaths in four women and a review of the literature

Four previously unpublished cases of female asphyxiophilia are presented. All women were found immobilised by obviously self-tied ropes, string or handcuffs. The women, who were alone at the time of death, died of a lethal paraphilia. The autopsies revealed asphyxiation as the cause of death, caused in two cases by suffocation as a result of hanging and strangulation and in the other two cases by plastic bags placed over the individuals head. In one case there was additional evidence at the scene that the deceased had inhaled ether. In none of the four cases was there any indication that the asphyxiation was due to homicide or suicide. Thus they can be described as accidental autoerotic deaths (AAD). The four cases closely mirror findings from scenes of male AADs, although autoerotic practices are generally believed to be rarer among females than in males. Received: 8 March 2001 / Accepted: 9 October 2001     

Syndrome of Alagille: radiological and sonographic findings A review of 37 cases

The objective of this study was to evaluate the association of intrahepatic cholestasis, pulmonary stenosis, and hyperlipemia with osseous and renal abnormalities in Alagille's syndrome. A total of 37 patients (25 males and 12 females) with ages ranging between 8 months and 27 years were included. Clinical records as well as radiological and ultrasonographic studies were reviewed. Chronic cholestasis was observed in all patients. Thirteen had favorable clinical outcome and normal hepatic sonograms. Clinical and sonographic evidence of portal hypertension was found in 13 patients and of cirrhosis in 8 patients. The remaining 3 patients required hepatic transplantation due to severe cholestasis. Hyperlipemia correlated with hepatic malfunction. Pulmonary stenosis and renal hypoplasia were the most frequently associated abnormalities. All patients showed a peculiar facies. Abnormal “butterfly” vertebrae were present in 18 patients and ulnar or phalangeal shortening in 11 patients. Ultrasonography allowed hepatobiliary disease assessment and helped to establish indications for hepatic transplantation. Renal and osseous abnormalities were not specific but in the appropriate clinical setting reinforced the diagnosis. Received 6 November 1995; Revision received 15 February 1996; Accepted 20 February 1996     

CT appearances in macronodular hepatosplenic tuberculosis: A review with five additional new cases

Pseudotumoral or macronodular hepatosplenic tuberculosis (HSTB) is rare. Only 31 cases have been documented in imaging literature so far. Presented is the clinico-imaging review with five additional new cases of this uncommon variety. Due to nonspecific wide spectrum of imaging appearances, biopsy is mandatory in almost all cases. Clinical recovery and resolution of lesions on imaging may not be directly proportional.     

The role of breast imaging in macrolane injection—A review and report of three cases

The demand for minimally invasive cosmetic procedures is increasing. Injectable hyaluronic acid is an effective and well tolerated procedure that can be used for breast augmentation and provides predictable long-lasting results if administered appropriately in the correct tissue plane. Concerns already exist regarding the effect of Macrolane™ on breast cancer screening, and we raise a new concern about the need for imaging for its safe administration. We present three cases referred to our centre in the last 2 years with complications associated with Macrolane™ injection, possibly from injection into an incorrect tissue plane. Complications included breast pain, haematoma, cellulitis and abscess formation. We suggest that such aesthetic procedures should be carried out under ultrasound guidance to ensure administration into the correct site, potentially avoiding such complications.