Brain death: neuropathological findings and forensic implications

'Brain death' is defined pathophysiologically as intracranial circulatory arrest. The morphological features of brain death include cerebral edema, absence of reactive changes, and--after an interval of 15-36 h--the morphological hallmarks of respirator brain: edema, global softening of the brain, dusky discoloration of the gray matter, and often necrotic and sloughing tonsillar herniations. The following implications of brain death for forensic medicine are discussed: discriminating between respirator and autolytic brain, declaration of death, determining the time of brain death versus the time of the traumatic event leading to brain death, and neuropathological control of the clinical diagnosis of brain death. These issues are elucidated and their bearing on forensic practice is illustrated by several real-life situations. Thus, neuropathological examination in the case of clinically diagnosed brain death is--without doubt--necessary in order to answer several questions often or regularly expected.     

Personality and divorce: a genetic analysis

M. McGue and D.T. Lykken (1992) found that divorce risk was, to a substantial degree, genetically mediated; prior research has identified numerous social and psychological factors that affect divorce risk (G.C. Kitson, K.B. Barbi, & M.J. Roach, 1985). The present study attempted to link these domains by examining the extent to which genetic influences on one such psychological factor, personality, explain divorce risk heritability. A sample of adult twins from the Minnesota Twin Registry completed a marital history questionnaire and the Multidimensional Personality Questionnaire (A. Tellegen, 1982). Positive Emotionality and Negative Emotionality factors were positively related to divorce risk, whereas Constraint was negatively related. In women and men, respectively, 30% and 42% of the heritability of divorce risk consisted of genetic factors affecting personality and divorce risk correlated largely as a result of these common genetic influences.     

Longer-term adjustment in children of divorce: Converging findings and implications for practice.

Reviews research on the impact of divorce on the long-term adjustment of children and adolescents. Variables associated with postdivorce outcomes include conflict, the adjustment of the custodial parent, the relationship with the noncustodial parent, child-rearing practices and child care, remarriage, and the type of custody arrangement. It is suggested that a balanced relationship with each parent that incorporates relevant aspects of the child's life should be developed after divorce. Parents should understand that it is the conditions created by divorce rather than divorce itself that determine their child's adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental conflict and the adjustment of children in divorce: Clinical and research implications.

Comments on issues raised by J. B. Kelly's (see record 1989-25605-001) article on factors affecting the adjustment of children to divorce, focusing on (1) the nature of conflict between parents in divorce and (2) interventions designed to manage that conflict. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The undetermined form of Chagas' heart disease: concept and forensic implications

The undetermined form of Chagas' disease is diagnosed in asymptomatic subjects with a positive blood test for Chagas' disease, normal resting electrocardiogram, chest X-ray, barium esophageal and large bowel radiological studies. Other investigation methods are not recommended for identification of other organs damage lesions in this phase of the disease. When other methods of investigation were employed, cardiac and digestive abnormalities of small magnitude were detected without prognostic implications. These findings do not warrant frequent examinations of patients with undetermined form of the disease except for the electrocardiogram or if the patients report other clinical manifestations. The benign course of the disease does not preclude ability to work and the subjects should be considered apt for work in any profession.     

Accepting forensic case referrals: Ethical and professional considerations.

As psychologists serve the legal system with increasing frequency, it is important to consider a number of critical issues at a case's inception, including the following: Who calls the psychologist? Who is the referral source? Who is the attorney? Who are the various parties involved in the case? What are the facts of the case? Does the psychologist have the expertise to clarify and develop technical issues of the case? Will the psychologist be expected to play an expert role or a consultant role? Who pays the psychologist? How are fees determined? What records should be kept? Answering these questions will help the psychologist avoid ethical, legal, and professional dilemmas and will allow the psychologist to perform an important service in helping the court to understand technical issues in reaching just decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hemorrhage into a simple liver cyst: diagnostic implications of a recent case

Hemorrhage complicating simple liver cyst is rare. On imaging studies, the differential diagnosis between intracystic hemorrhage and cystadenocarcinoma of the liver is unreliable, and hepatectomy has been performed for benign liver cyst in this situation. We describe the characteristics of hemorrhage into a liver cyst in a patient who underwent dome resection of the cyst. In our patient, important diagnostic findings included benign cytologic features in a cyst fluid specimen aspirated with ultrasonographic guidance and a fall in hemoglobin and hematocrit, suggestive of hemorrhage. Other informative features were absence of communication between the intrahepatic bile ducts and the cystic liver lesion upon endoscopic retrograde cholangiopancreatography, as well as benign intraoperative frozen-section histology.     

Parental functioning and children's adjustment in families of divorce: a prospective study

This paper prospectively examined relations between marital status, predivorce parenting practices, and children's adjustment, using data from the New York Longitudinal Study (NYLS). Prospective analyses of children's predivorce adjustment indicated that neither boys nor girls showed more problematic behavior prior to parental separation, and only boys had more difficulties after divorce. However, parents of to-be-divorced families reported more difficulties in childcare practices before divorce than did parents of always-married families. Parenting difficulties in to-be-divorced families were found consistently for boys but not for girls. Results suggest that the difficulties found among boys after divorce may be linked with parenting problems that begin before divorce.     

Preoperative hair removal: a case report with implications for nursing

Experimental acute subdural hematoma in the rat has been shown to produce a zone of apparent infarction under the clot, and excitatory amino acid toxicity appears to play a role in the damage observed. We report the effect of dextromethorphan, a commonly used antitussive and a noncompetitive NMDA-type glutamate receptor antagonist, on the volume of histologic damage seen at 72 h after acute subdural hematoma in the rat. Sixty-five Long-Evans rats underwent placement of acute subdural hematoma using the "cranial window" model. Fourteen animals received oral dextromethorphan, 10 mg/kg/dose, twice daily for 3 days, and an additional 20 animals also received a single 20 mg/kg intraperitoneal dose 15 min after clot placement in addition to the oral regimen. Control animals received equal volumes of sterile water. Brain lesions in all animals were characterized by well-circumscribed infarctions underlying the subdural hematoma. Lesion volume in control animals was 88.3 +/- 9.3 mm3 (mean +/- standard error of the mean), while animals receiving dextromethorphan had significantly smaller lesions, which was independent of dosing schedule (59.9 +/- 9.2 mm3)(p = 0.0403). Animal weight was also found to be a significant covariate (p = 0.038). Because of its safety in humans and efficacy as a neuroprotectant in a variety of models, dextromethorphan may be a promising agent for clinical use, particularly in children.     

Examining race and culture in psychology journals: The case of forensic psychology.

Scholars have argued that racial-cultural issues should be given more attention in psychological research. The American Psychological Association (APA) has instituted guidelines and policies about how to include race and culture in research, theory, and practice. Members of racial minority groups are overrepresented in populations served by forensic psychologists. This article reviews content analyses of racial-cultural issues in psychology and presents a content analysis of the treatment of race and culture in 7 forensic psychology journals between 1998 and 2003. Results indicate that less than 10% of the empirical articles addressed issues of race or culture with any depth and that the majority of the articles used a cultural deprivation paradigm. Results and recommendations for practice and future study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anesthetic implications for implantation of a left ventricular assist device: a case study

Restenosis after coronary angioplasty is a major limitation of an otherwise highly effective and safe procedure for the treatment of atherosclerotic coronary artery disease. Although the advent of coronary stenting has reduced restenosis rates for selected patients, an overall restenosis rate of 20% to 25% remains. Despite numerous trials, no effective pharmacologic therapy has been found. Intracoronary irradiation is a new technique proposed to prevent restenosis after angioplasty. In animal models of restenosis after balloon injury, there is marked reduction of neointimal proliferation when the injured vessel is irradiated, using a variety of radiation sources and delivery systems. Early human trials have underscored the importance of careful source calibration and dosimetry. A small, randomized, double-blind, placebo-controlled study of intracoronary irradiation to prevent recurrent restenosis recently reported striking reductions in angiographic restenosis as well as clinical event rates. A number of important issues remain unresolved, such as defining which component of the arterial wall serves as the target tissue for radiation, the minimal effective dose, the maximum tolerable dose, and user-friendly radiation delivery systems. Further studies are needed to define the safety, efficacy and the ultimate usefulness of intracoronary irradiation as an adjunct to current procedures in interventional cardiology.     

1,000 forensic outpatients: a descriptive study

The case notes and court reports of 1,000 consecutive outpatient referrals to a regional forensic outpatient service were studied retrospectively. Socio-demographic, psychiatric and forensic information was collected. The sample was predominantly male, Caucasian and relatively young in comparison with a general psychiatric population. The commonest source of referral was from defense solicitors and the commonest reason for referral was for a court report. A wide range of diagnoses and offences were noted. A number of differences were found in the frequency of gender, ethnicity and diagnosis according to the source of, and reason for, referral.     

Subjective interpretation, laboratory error and the value of forensic DNA evidence: three case studies

This article discusses two factors that may profoundly affect the value of DNA evidence for proving that two samples have a common source: uncertainty about the interpretation of test results and the possibility of laboratory error. Three case studies are presented to illustrate the importance of the analyst's subjective judgments in interpreting some RFLP-based forensic DNA tests. In each case, the likelihood ratio describing the value of DNA evidence is shown to be dramatically reduced by uncertainty about the scoring of bands and the possibility of laboratory error. The article concludes that statistical estimates of the frequency of matching genotypes can be a misleading index of the value of DNA evidence, and that more adequate indices are needed. It also argues that forensic laboratories should comply with the National Research Council's recommendation that forensic test results be scored in a blind or objective manner.     

Atypical case of Smith-Lemli-Opitz syndrome: implications for diagnosis

Anti-GQ1b antibodies were assayed by an enzyme-linked immunosorbent assay in sera from patients with non-neurological disorders (N = 20), and with various neurological disorders (N = 59), including nine cases of Miller Fisher syndrome, 16 cases of Guillain-Barré syndrome and one case of acute post-infectious ophthalmoparesis. Such antibodies were found in most cases (8 out of 9) of Miller Fisher syndrome, and at very high titres, in one case of Guillain-Barré syndrome characterised by an initial ophthalmoparesis, and in the case of isolated post-infectious ophthalmoparesis. The latter was characterised by a long-lasting occurrence of these antibodies. Anti-GQ1b antibodies are specific for an immune-mediated neuropathy of the cranial, especially oculomotor, nerves.     

Nutritional implications of xerostomia and rampant caries caused by serotonin reuptake inhibitors: a case study

Serotonin reuptake inhibitors, such as fluoxetine, fenfluramine, and dexfenfluramine, are frequently used to treat obesity, depression, and bulimia. A common side effect of these medications is xerostomia, or dry mouth. A case study demonstrating the impact of drug-induced xerostomia on oral health and subsequent nutrition implications is presented. Rampant caries can result from a combination of xerostomia and inappropriate dietary and oral hygiene habits. Preventive dietary and dental guidelines are presented to assist nutrition and dental professionals in treating and counseling patients with xerostomia.     

Parental divorce: Effects on individual behavior and longevity.

Using an archival prospective design, the authors studied associations among parental divorce occurring during participants' childhood, adult psychosocial mediators, and mortality over the life span of a subgroup of participants (N?=?1,261) in the Terman Life Cycle Study (1921–1991). Children from divorced families grew up to show a higher risk of premature mortality across the life span. The higher mortality risk for men was explained, in part, when 3 mediating factors were controlled: Men who had experienced parental divorce were more likely to have their own marriages end in divorce, obtained less education, and engaged in fewer service activities. Women who had experienced parental divorce smoked more and were more likely themselves to divorce, both of which predicted higher mortality risk. The findings extend previous work on the negative sequelae of parental divorce to long-term effects on personality and longevity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)