Integrating engineering principles into the medico-legal investigation of a rare fatal rollover car accident involving complex dynamics

Rollover car accidents can be the result of forceful steering or hitting an obstacle that acts like a ramp. Mortality from this type of car accident is particularly high, especially when occupants are thrown out of the vehicle. We report a case of a 67-year‐old man who died after a rollover accident that occurred when he was driving a car equipped with a glass moonroof. He was found inside his car with his safety belt correctly fastened and the roof shattered. At autopsy, a wide avulsion injury of the head was observed, which was associated with an atlanto-axial dislocation and full‐thickness fracture of the cervical body and posterior facet joints of the seventh cervical vertebra. The data collected at the scene of the accident were integrated with the autopsy results to yield a forensic engineering reconstruction. This reconstruction elucidated the dynamics of the event and correctly ascribed the lesions observed at autopsy to the phases of the rollover. Afterward, an analysis of the scientific literature concerning rollover crash tests was conducted to understand why the driver sustained fatal injuries even though his seatbelt was properly fastened.     

Decapitation with egg shelling of the skull in a road traffic accident: a case report

A 40-year-old lady was found dead on a road early one morning. She had allegedly been run over by a speeding vehicle. The head of the deceased had been decapitated, with egg shelling of the skull from the scalp and face. The skull was lying a little distance away from the rest of the body. Although decapitation is not an unknown entity in a road traffic accident, subsequent egg shelling of the skull, leaving behind scalp and face tissue, has not been reported in a road traffic accident in the forensic literature.     

Assessment of the responsibility between a road traffic accident and medical defects after the traffic accident injury of knee joint

A 48-year-old Chinese woman was hit by a car in a road traffic accident. Local county hospital considered that her right knee was injured, but didn't find any sign of fracture from X-ray imaging. Then the hospital gave diagnosis of soft tissue contusion and the patient started to exercise with burden 21 days after her right lower limb was fixed by plaster slab. Four months later, she had to go back to the county hospital for recheck due to persistent pain on her right knee. Then, the right tibia outer plateau fracture was found. The patient rejected the advice of open reduction and internal fixation of right tibia plateau fracture. Instead, she accepted the unicompartmental knee arthroplasty in a hospital affiliated to a medical college. The patient felt the knee pain alleviated after surgery However, the joint dysfunction was aggravated even more. The patient used the legal procedure for personal compensation. Both driver and the insurance company disputed that the final consequence of the injured knee was due to not only the traffic accident, but also poor medical practice involved. Therefore the court consigned us to make judicial judgment of expertise. After investigation, we found the earliest X-ray graph after the accident had shown the fracture of right tibia outer plateau and right knee valgum, with articular surface involvement, and the traffic accident was considered as the primary cause of sequelae. At the same time, the county hospital missed the diagnosis of fracture, and led to insufficient fixation of right lower limb, which was not good for rehabilitation from fracture and joint injury. This was the secondary cause of sequelae. Additionally, instead of the standard therapy, the affiliated hospital of medical college made the unicompartmental knee arthroplasty four months later, which also had a little defect. It was the minor reason for the result.     

Carbon-monoxide poisoning, behavioural changes and suicide: an unusual industrial accident

We report a case of CO intoxication caused by a motor vehicle's faulty heating-system. A truck driver experienced severe mental deterioration, behavioural changes and delirium after acute CO intoxication and committed suicide 15 months later. This report examines the pathogenetic mechanism of CO, the immediate and delayed consequences of CO intoxication, diagnostic difficulties and current treatment options. The medical-legal aspects of the case are discussed.     

Teratoma of the parotid region: an uncommon disease. Apropos of a case with review of the literature

Cervicofacial teratoma is an infrequently reported tumor that is usually diagnosed at birth and is very rarely seen after one year of age. In the case reported, an exceptional finding was a teratoma of the parotid region in an adolescent. A literature review underlines the rarity of the lesion, diagnosis being assisted by radiologic and CT scan imaging.     

Aspergillus spondylitis involving the cervico-thoraco-lumbar spine in an immunocompromised patient: a case report.

Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient.     

Ice skating injuries: a survey of cases seen in an accident and emergency department.

Participating in sporting activities has its risks as well as its benefits. A simple study is described which documents the patients presenting at a casualty department after injury at an ice rink. Epidemiological data, risk factors and patterns of injury are discussed.     

7例特殊军训伤横纹肌溶解症救治体会

横纹肌溶解症 (Ｒｈａｂｄｏｍｙｏｌｙｓｉｓ)可分为创伤性和非创伤性 ,非创伤性的病因多为醉酒、中毒、癫痫发作、肢体缺血、代谢紊乱等 ,创伤性则多见于严重创伤、手术、挤压综合征、剧烈运动等。其常见和严重的并发症为急性肾衰 ,所以诊断和处理不及时可造成严重后果 ,国内外均有报告。但是 ,军事训练所致的横纹肌溶解症国内尚未见报告。我院自 1 993年至今共收治此类病人 7例 ,1例死亡 ,6例经及时诊断和治疗均顺利康复 ,现报告如下。1　临床资料1 1　一般情况　7例均为男性武警战士 ,年龄 2 0～ 2 3岁 ,发病季节在 6月、7月 ,原因均为…     

Mission creep: an analysis of accident and emergency room activity in a military facility in Bosnia-Herzegovina

OBJECTIVE: To evaluate accident and emergency (A&E) room activity at a Role 3 Multinational Integrated Medical Unit (R3 MIMU) facility in Bosnia-Herzegovina. METHODS: Retrospective analysis of all patients attending the A&E room from 1st October 1999-30th September 2002. RESULTS: 1864 casualties are included in the analysis. 52.1% of casualties were Bosnian, 43.8% were military. Mean age of casualties was 35.5 years (SD 18.3), range 1-88 years. Traumatic injury was the leading cause of presentation (58.1%). Following treatment 66.7% of all cases were discharged or returned to unit, with 19.8% admitted to a ward area. During the 3 year period there was a 5 fold increase in the number of Bosnian nationals treated, this included 80 children (<13 years). CONCLUSION: There has been a dramatic increase in Methods A&E use during the period evaluated, Setting of study particularly by the local population. The increasing number of locals treated, both adult and child, has the potential to undermine the R3 MIMU mission and increase dependency within the Bosnian population. A balance is needed to ensure the staff and functions of a hospital are maintained whilst preserving the capability to deal with an influx of military casualties.     

When the envelope pushes back: a combat aviator experiences barotrauma after descending with an ear block

While deployed to a war zone, an aviator displayed poor aeromedical judgment and flew with an upper respiratory infection and an ear block. This resulted in a tympanic membrane perforation and the medical grounding of the member for 10 days. The discussion involves the probable mechanism of injury and the requirements of the Naval Aerospace Medical Institute regarding perforations, as well as the reasoning behind the flight surgeon's choice of treatment.     

Retractile mesenteritis involving the colon: barium enema, sonographic, and CT findings

Retractile mesenteritis is a rare disorder characterized by either focal or diffuse thickening of the mesentery due to chronic inflammation and fibrosis. Six cases are reported in which stenosis of the colon, an uncommon complication of retractile mesenteritis, was the predominant radiologic finding. Diagnosis was suggested by the tapered, serrated appearance of the stenotic segment on barium enema complemented by the findings on sonography and CT.     

A magic sword or a big itch: an historical look at the United States biological weapons programme.

In the late 1950s interest in entomological warfare increased, and literature describing the US biological warfare programmes on the use of the mosquito Aedes aegypti, the vector for transmitting yellow fever, has now been released. Yellow fever was considered as a suitable disease to use in southern regions of the former Soviet Union. The US destroyed its biological weapon stockpiles in the early 1970s. In addition to its offensive biological warfare programme, the US conducted extensive trials to assess its own vulnerability to biological attack. These trials and a later series of threat analyses indicate that biological agents could, indeed, affect large areas of the US if the attackers were allowed to proceed unmolested. Some of the threat analyses present highly questionable scenarios.     

Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder: ultrasound and CT findings

We report the imaging findings in a case of Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder. Ultrasound and CT demonstrated multiple nodular masses in the pelvis of the transplanted kidney, ureter and bladder. The masses enhanced well on CT following i.v. contrast medium.     

Primary lymphoma of the liver: an uncommon disease. Ultrasonic and x-ray computed tomographic aspects. Apropos of a case with review of the literature

Although the very rare primary non-Hodgkin's lymphoma is resectable and responds to chemotherapy it has a very poor prognosis since the outcome was rapidly fatal in 7 of the 11 cases reported in the literature. Particular features in a patient with a primary non-Hodgkin's lymphoma of cirrhotic liver were the association of portal hypertension and portal thrombosis related to tumor invasion. Findings on ultrasound imaging and histologic diagnosis from guided needle puncture biopsy appear to be previously unreported aspects of this affection.