Legal medicine
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Modern medicine was first introduced into Taiwan by missionary hospitals in 1865. However, Japanese governors following Japan's medical reform applied modern medicine as the standard of practice in the year 1896. They also imported 150 doctors from Japan to promote public hygiene and control infectious diseases, such as malaria, plague, cholera, dysentery, etc. ⋯ The general environment for medical practice in Taiwan has changed greatly in the past 60years. It is time for us to look around the world to set up standards of negligence for both clinical and criminal cases as soon as possible. In the mean time, the Department of Health should consider adopting the Good Medical Practice guidelines from the United Kingdom to strengthen the administrative power to regulate physicians' behaviors.
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Chronic kidney disease and elevated serum C-reactive protein (CRP) have been suggested as clinical risk factors for cardiac attacks. The present study investigated postmortem blood urea nitrogen (BUN), creatinine (Cr) and CRP levels in the peripheral blood of sudden cardiac death cases. Adult autopsy cases of ischemic heart diseases (n=153, >20 years of age), including acute myocardial infarction (AMI, n=71), recurrent myocardial infarction (RMI, n=47), acute ischemic heart disease without infarction (AIHD, n=27) and chronic ischemic heart disease (CIHD, n=8), were examined and compared with chronic congestive heart disease (CHD, n=24), spontaneous cerebral hemorrhage (SCH, n=17) and mechanical asphyxiation (n=32). ⋯ Heart weight was larger for all heart diseases and SCH than for asphyxiation, and was larger for RMI and CHD but lower for AIHD and CIHD among them. Body mass index (BMI) was slightly higher for AMI, RMI, AIHD and CHD, remaining within the reference interval in most cases, but was lower for CIHD. These findings suggest different risk factors or etiologies, including active atherosclerosis, latent renal failure, dehydration and cardiac hypertrophy, for sudden deaths due to these heart diseases.
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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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Previous studies have suggested the usefulness of postmortem serum calcium (Ca) and magnesium (Mg) for investigating cause of death. The present study investigated their levels in the pericardial fluid of serial autopsy cases of adults within 48 h postmortem (n=385), including fatalities from blunt injury (n=57), sharp instrument injury (n=9), mechanical asphyxiation (n=28), salt- and freshwater drowning (n=14 and n=61, respectively), fire fatality (n=35), intoxication (n=23), hypothermia (cold exposure, n=12), hyperthermia (heat stroke, n=7), acute cardiac death (ACD, n=86), pneumonia (n=9) and spontaneous cerebral hemorrhage (n=11). The pericardial Ca level was independent of the postmortem interval, showing a value similar to that of the clinical reference range in cases other than saltwater drowning, while the Mg level was higher than the clinical reference range and showed a mild postmortem time-dependent increase. ⋯ The Mg level was also significantly higher for saltwater drowning than the other groups, and showed a higher level for sharp instrument injury, but a lower level for hypothermia. The Mg/Ca ratio was higher for sharp instrument injury and saltwater drowning, but was lower for hypothermia. These findings suggest that postmortem pericardial Ca and Mg can be used to investigate the cause of death, especially for saltwater drowning, hypothermia and hyperthermia.
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In cases of shock, the lung weight decreases due to massive hemorrhaging, but increases due to progressive congestion and edema caused by microvascular injury. To examine the relationship between postmortem lung weight and survival time, the present study investigated serial autopsy cases (n=904), including those with fatalities from blunt injury (n=328: head injury, n=191; others, n=137), sharp instrument injury (n=70), mechanical asphyxiation (n=80), intoxication (n=62), drowning (n=75), fire fatality (n=184), and acute myocardial infarction/ischemia (AMI, n=105). ⋯ The total lung weight showed a survival time-dependent increase for blunt and sharp instrument injuries, fire fatality, and mechanical asphyxiation; however, such a finding was not seen in the cases of AMI, drowning, or intoxication. These findings suggest that an increase in lung weight due to progressive congestion and edema and a heavier lung weight may indicate a longer survival time.