Legal medicine
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Our society is the only country that punishes physicians with medical malpractice by using criminal law as a routine, while most countries in this planet settle almost all medical disputes with civil action. In Taiwan, criminal suits account 79% of all medical malpractice law suits. The purpose of this trial is to investigate the reasons for the overruled criminal judgment by empirical approach. ⋯ The criminal rate of physicians in Taiwan is the highest in all professionals in the world. Most of these criminal doctors were the laborious, mind-dependent, life-saving surgeons, internists, pediatricians, and gynecologists. According to the causes of the disputes, the difference between the expectation of the doctors and that of the patients should be treated by informed consent doctrine to avoid the very expensive defensive medicine.
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Pulmonary surfactant-associated proteins A and D (SP-A and -D) are tissue-specific components. Previous studies showed an increase in the postmortem serum SP-A level due to acute pulmonary alveolar damage and acute respiratory distress. The present study comparatively investigated serum SP-A and SP-D levels with regard to the cause of death in serial medicolegal autopsy cases (n=679, within 48 h postmortem). ⋯ Both SP-A and -D levels in bilateral cardiac blood were significantly higher for drowning and secondary pulmonary damage involving ARDS after traumas, but were lower for hypothermia (cold exposure). SP-A was predominantly elevated in fire fatality and delayed deaths from injury and fires, while pneumonia showed a predominant elevation of SP-D. These findings suggest that comparative analysis of serum SP-D and SP-A is useful for investigating primary or secondary pulmonary alveolar damage in the death process.
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Previous studies have suggested the usefulness of the postmortem serum S100B level as a marker of the severity of brain damage. In this study, we investigated the S100B level in the cerebrospinal fluid (CSF) in serial autopsy cases (n=216, within 3 days postmortem), including those of blunt injury (n=34: fatal head injury, n=20; others, n=14), sharp instrument injury (n=9), mechanical asphyxiation (n=19), drowning (n=11), fire fatality (n=26), intoxication (n=20), hypothermia (cold exposure, n=16), hyperthermia (heat stroke, n=9), acute cardiac death (n=52) and pneumonia (n=20). ⋯ In fatal head injury cases, however, CSF S100B did not correlate with the survival time or postmortem interval. A CSF S100B level of >2000 ng/ml in the early postmortem period might be considered a biochemical sign of fatally severe brain damage.
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The present study focuses attention upon the relationship among postmortem mRNA levels of pulmonary glucose transporter (GLUT1) and vascular endothelial growth factor (VEGF) to lung weight to investigate pulmonary pathophysiology in the death process. Autopsy cases (n=173, within 48 h postmortem) of blunt injury, including head injury (brain contusions and acute subdural hemotoma) and non-head injury, sharp instrument injury, mechanical asphyxiation, drowning, acute myocardial infarction/ischemia (AMI) and idiopathic cerebral hemorrhage (ICH) were examined. GLUT1 and VEGF mRNAs were quantified by TaqMan real-time RT-PCR for the upper lobes of the bilateral lungs. ⋯ Such findings were not detected for other groups. These findings indicate parallel increases in hypoxia-induced responses and lung weight in ICH and brain contusions, suggesting different pulmonary hemodynamics with milder alveolar damage compared with other groups, including AMI and acute subdural hematoma. Different mechanisms might be involved in non-cardiogenic or neurogenic pulmonary congestion and edema for ICH/brain contusions and subdural hematoma.
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Previous studies suggested the usefulness of postmortem cardiac troponin (cTn) and creatine kinase MB (CKMB) levels in blood and pericardial fluid for investigating myocardial damage in the death process. The present study investigated the postmortem levels in cerebrospinal fluid (CSF), using serial medicolegal autopsy cases (n=257, within 48h postmortem). For CSF, the postmortem increase was slight for cTnT and cTnI, and was not significant for CKMB. ⋯ Increased CKMB was apparently independent of the cause of death, and was frequently seen in acute or subacute deaths. These findings suggest that CSF levels of cTnT and cTnI are useful for investigating the progress and duration of myocardial damage in the death process. CKMB may be used as a marker of persistent hypoxic myocardial damage before death.