Evidence Of Previous Trauma Research Articles

Ensuring Appropriate Expert Testimony for Cases Involving the “Shaken Baby”

Ensuring Appropriate Expert Testimony for Cases Involving the “Shaken Baby”

Microscopic evidence of previous trauma to the hyoid bone in a homicide involving pressure to the neck

Post-mortem examination of a female homicide victim suggested a fracture of the larynx and increased flexibility, without associated hemorrhage, of the hyoid bone. There was a history of domestic violence, which included an allegation of attempted strangulation. Microscopy confirmed a recent fracture of the larynx and showed evidence of a healing fracture in the hyoid bone. Death was due to multiple blunt force trauma, including pressure to the neck. The deceased's partner admitted strangulation and was convicted of murder. The discussion concentrates on causation of laryngo-hyoid fractures and the potential usefulness of microscopy, particularly identifying evidence of previous trauma.

Patient with Syphilitic Thoracic and Abdominal Aortic Aneurysms

Patient with Syphilitic Thoracic and Abdominal Aortic Aneurysms We are presenting a rare case of patient with two syphilitic aneurysms localized in thoracic and abdominal aorta. Routine lung computer tomography (CT) for the patient with complains about irritating and unclear ethiology cough revealed 10 cm diameter aneurysm of descending thoracic aorta (TAA) and additionally 4.8 cm aneurysm of abdominal aorta (AAA) just below the aortic hiatus. As there was no evidence of previous trauma, Marfan syndrome or connective tissue disease patient was screened for syphilis. Diagnosis of tertiary syphilis was confirmed and specific treatment started. As complains of irritating cough intensified - patients TAA was successfully treated endovascularly with thoracic stent graft (Valiant®Captivia, Medtronic Ltd.) on emergency basis. On control CT angiography 3 month after treatment there was no evidence of graft migration, endoleaks and aneurysmal sac was thrombosed. AAA has not increased in size, and open repair is planned.

Healing of Nonhymenal Genital Injuries in Prepubertal and Adolescent Girls: A Descriptive Study

The objective of this study was to identify the healing process and outcome of nonhymenal injuries in prepubertal and pubertal girls. This multicenter, retrospective project used photographs to document the healing process and outcome of nonhymenal genital injuries in 239 prepubertal and pubertal girls whose ages ranged from 4 months to 18 years. The genital injuries sustained by the 113 prepubertal girls consisted of 21 accidental or noninflicted injuries, 73 injuries secondary to abuse, and 19 injuries of unknown cause. All 126 pubertal girls were sexual assault victims. These nonhymenal genital injuries healed at various rates depending on the type and severity. There was no statistical difference in the rate of healing between the 2 groups. Abrasions disappeared by the third day after injury. Edema was no longer present by the fifth day. Ecchymosis (bruising) resolved within 2 to 18 days depending on the severity. One prepubertal girl still had a labial hematoma at 2 weeks. Submucosal hemorrhages of the vestibule and fossa navicularis resolved between 2 days and 2 weeks. Petechiae and blood blisters proved useful for approximating the age of an injury. Petechiae were gone by 24 hours, whereas blood blisters were detected at 30 days in a prepubertal girl and 24 days in a pubertal girl. The depth of a laceration determined the time required for it to heal. Superficial vestibular lacerations seemed healed in 2 days, whereas deep perineal lacerations required up to 20 days. The appearance of new blood vessel formation was detected only in prepubertal girls, whereas scar tissue formation occurred only after a deep laceration in both groups. The majority of these nonhymenal genital injuries healed with little or no evidence of previous trauma. The time required for resolution varied by type, location, and severity.

Milialike Idiopathic Calcinosis Cutis in Down's Syndrome

To the Editor.— We present what we believe to be the first reported case of idiopathic calcinosis cutis in Down's syndrome. Report of a Case.— A 6-year-old boy with documented trisomy 21 was first seen in April 1987 for whitish papules on the hands, feet, legs, and face (Fig 1) of 2 year's duration. The lesions appeared initially on the left hand at the border of a previous thermal burn. Diagnosis of milia was made at that time. However, lesions began to appear on nonburned skin and rapidly increased in number. The lesions have always been asymptomatic. On examination there were dozens of discrete whitish 1- to 3-mm, round, firm papules grouped over the dorsum of the hands, wrists, elbows, knees, and face. There was no evidence of previous trauma or inflammation in the involved area other than the healed burn scar on the left hand. Three separate skin biopsy