clinical forensic medicine

临床法医学
  • 文章类型: Systematic Review
    分析钝器创伤的能力对于破译有关伤害机制的有价值线索以及作为医学法律调查的证据至关重要。在过去的十年中,已经研究了替代光源(ALS)的使用,并建议在瘀伤评估期间优于常规白光(CWL)。为了响应全世界对该技术日益增长的兴趣,根据系统评价和荟萃分析(PRISMA)的首选报告项目对文献进行了系统综述,以探讨ALS检测和观察瘀伤的能力.从最初的4055条记录中确定,10项研究符合合格标准,并入选本综述.评估还包括一个新颖的框架,被称为SPICOT,进一步系统地评估法医文献中的科学证据和偏见风险。分析表明,红外或紫外光谱范围内的窄带波长在可视化或检测瘀伤方面并没有明显优于CWL。然而,可见光谱内的波长,特别是415nm与长通或带通黄色滤光片相结合,更有效。然而,大多数选定的研究只涉及ALS的敏感性,因此,只有在已知瘀伤的位置时,结果才可能被认为是有效的。需要进一步调查以了解ALS的特殊性,特别是如何使用外用化妆品,以前的伤口/疤痕组织,纹身,痣和雀斑可能会影响检测。在将ALS实施为常规实践之前,在前景讨论中也应考虑对增强的可视化创伤的解释的伦理关注。然而,这篇综述发现,可见光谱内的窄带ALS证明了改善损伤记录的潜力,在瘀伤的检测和可视化方面优于CWL。
    The ability to analyze blunt-force trauma is crucial for deciphering valuable clues concerning mechanisms of injury and as evidence for medico-legal investigations. The use of alternate light sources (ALS) has been studied over the past decade, and is proposed to outperform conventional white light (CWL) during bruise assessments. In response to the growing interest of the technology worldwide, a systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to address the ability of ALS to detect and visualize bruising. From an initial 4055 records identified, ten studies met the eligibly criteria and were selected for this review. Evaluation also included a novel framework, referred to as SPICOT, to further systematically assess both scientific evidence and risk of bias in forensic literature. Analysis reveals that narrowband wavelengths within in the infrared or ultraviolet spectral ranges do not significantly outperform CWL in visualizing or detecting bruising. However, wavelengths within the visible spectrum, particularly 415 nm combined with longpass or bandpass yellow filters, are more effective. However, the majority of selected studies only address the sensitivity of ALS, and therefore, results may only be considered valid when the location of a bruise is known. Further investigation is required to understand the specificity of ALS, in particular how the use of topical cosmetic products, previous wounds/scar-tissue, tattoos, moles and freckles may affect detection. The ethical concern regarding the interpretation of enhanced visualized trauma should also be considered in prospect discussions prior to implementing ALS into routine practice. Nevertheless, this review finds that narrowband ALS within the visible spectrum demonstrates potential for improved injury documentation, outperforming CWL in the detection and visualization of bruising.
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  • 文章类型: Journal Article
    目的:本研究旨在评估医学本科生对临床法医学(CFM)培训(动手和床边)的需求,并确定基于技能的教学方法在CFM中的实用性。
    方法:在政府医学院进行了一项横断面研究,我们使用混合模型方法(定性和定量组件)来访问三组的方法,每组50名参与者来自(1)住院医生/实习生,(2)教员,(三)伤亡医务人员,面向基于技能的CFM教学。对所有研究参与者进行结构化的预先测试问卷。问卷基于他们对临床实践中面临的法律问题的看法以及他们对CFM需求的态度。随后是为每组10名参与者分别安排的焦点小组讨论(FGD)。每个FGD会话持续40分钟,主持人和记录器。
    结果:目前的MBBS(医学学士和外科学士)课程很早地教授CFM,得到了20名(40%)教师的强烈同意,四名(8%)实习生,和三名(6%)医务人员。40名(80%)实习生,43(86%)的医务人员,40(80%)的教师需要在MBBS课程中进行CFM实践培训。法医学专家应处理临床医学法律案件(MLC),根据50名(100%)教师的同意,46名(98%)实习生,和47名(94%)医务人员。
    结论:需要在CFM中进行动手培训,以便为医生处理MLC提供更好的实用方法。应在第二年的MBBS课程中引入动手培训,他们的临床方面应与临床科目同时教授,直到实习。
    OBJECTIVE: This study was conducted to assess the need for clinical forensic medicine (CFM) training (hands-on and bedside) in medical undergraduate students and to determine the utility of skill-based teaching methodology in CFM.
    METHODS: A cross-sectional study was carried out in the Government Medical College, where we used the mixed model approach (qualitative and quantitative component) to access the approach of three groups containing 50 participants each from (1) resident doctors/interns, (2) faculty, (3) casualty medical officers, toward skill-based teaching of CFM. A structured pretested questionnaire was administered to all study participants. The questionnaire was based on their perception regarding the legal problems faced during clinical practice and their attitude toward the need for CFM. It was followed by a focus group discussion (FGD) arranged separately for each group of 10 participants. Each FGD session lasts for 40 minutes with a moderator and recorder.
    RESULTS: Present MBBS (Bachelor of Medicine & Bachelor of Surgery) curriculum teaches CFM very early is strongly agreed by 20 (40%) of the faculty, four (8%) of interns, and three (6%) of medical officers. 40 (80%) of interns, 43 (86%) of medical officers, and 40 (80%) of faculty necessitate hands-on training in CFM in the MBBS curriculum. Forensic medicine specialists should handle clinical medico-legal cases (MLCs), as agreed by 50 (100%) faculty, 46 (98%) interns, and 47 (94%) medical officers.
    CONCLUSIONS: Hands-on training in CFM is needed for a better practical approach for doctors toward handling MLCs. Hands-on training should be introduced in the second-year MBBS curriculum, and their clinical aspects should be taught simultaneously with clinical subjects till the internship.
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  • 文章类型: Journal Article
    与标准的临床法医检查相比,对活体勒死受害者进行磁共振成像(MRI)的初步经验证明了内伤的其他发现。然而,现有的MRI用于此目的的研究主要集中在事件发生后的前48小时。这项研究的目的是(a)通过在12天内进行两次MRI检查以及两次MRI扫描之间至少四天来评估暴力侵害颈部后MRI发现的纵向可见性;(b)评估哪些MRI序列最有助于检测损伤。20名绞窄受害者参加了这项研究,并进行了一次(n=8)或两次(n=12)MRI扫描。在最初的五天内进行了第一次MRI检查,事件发生后的第二个五到十二天。两名失明的放射科医生评估了MRI数据,并在颈部结构中寻找病变。总的来说,在32次MRI检查中报告了140个发现。大多数发现是在甲状腺和颈部肌肉中检测到的。具有脂肪抑制功能的T2加权空间,T1加权TSE和T1加权MPRAGE被评为最有帮助的MRI序列。在初次扫描中显示发现的受试者在第二次扫描中也显示出可比的结果,事件发生后平均8.4天进行。我们的结果显示,即使在事件发生后的12天内,除了标准的临床法医检查外,颈部MRI检查提供的信息可能会极大地受益于勒死案件的刑事诉讼。
    Initial experiences with magnetic resonance imaging (MRI) of living strangulation victims demonstrated additional findings of internal injuries compared to the standard clinical forensic examination. However, existing studies on the use of MRI for this purpose mostly focused on the first 48 h after the incident. The aims of this study were (a) to evaluate the longitudinal visibility of MRI findings after violence against the neck by performing two MRI examinations within 12 days and a minimum of four days between both MRI scans and (b) to assess which MRI sequences were most helpful for the detection of injuries. Twenty strangulation victims participated in this study and underwent one (n = 8) or two (n = 12) MRI scans. The first MRI examination was conducted during the first five days, the second five to 12 days after the incident. Two blinded radiologists assessed the MRI data and looked for lesions in the structures of the neck. In total, 140 findings were reported in the 32 MRI examinations. Most of the findings were detected in the thyroid and the muscles of the neck. T2-weighted SPACE with fat suppression, T1-weighted TSE and T1-weighted MPRAGE were rated as the most helpful MRI sequences. Subjects who showed findings in the initial scan also demonstrated comparable results in the second scan, which was performed on average 8.4 days after the incident. Our results show that even up to 12 days after the incident, the criminal proceeding of strangulation cases may greatly profit from the information provided by an MRI examination of the neck in addition to the standard clinical forensic examination.
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  • 文章类型: Journal Article
    儿童性虐待是一个公共卫生问题,影响到全世界所有种族的儿童,教育,和社会经济团体。这些攻击是极其危险的,不仅是因为他们在虐待时受到了直接的身体创伤,但他们也有长期的后果,可以恶化未来质量的受害者的生活。通过法医学和Deontology诊所的材料,对与儿童性虐待有关的所有病例进行了五年的回顾性研究,索菲亚,保加利亚。95例涉及男女儿童。外伤经过仔细检查,并根据其在受害者身上的定位以及报告的袭击事件后过去的时间进行分类。在性暴力案件中,最翔实和指出暴力的确切类型是位于肛门生殖器区域的伤害。太频繁了,缺乏物理发现,取决于性暴力的类型或与犯罪后的长时间相关。孩子们不知道他们在遭受这种创伤后必须做什么,或者他们害怕与不同的家庭成员分享他们的经验,这可能导致法医检查较晚,缺乏物理和生物学发现,这是刑事起诉犯罪中最关键的痕迹,这可能是肇事者不被指控其非法行为的可能性。
    Child sexual abuse is a public health problem that affects children worldwide in all ethnic, educational, and socioeconomic groups. These assaults are extremely dangerous not only due to their direct physical traumas received at the time of the abuse, but they also have long-term consequences that can worsen the future quality of the victim\'s life. A retrospective study of all cases related to child sexual abuse for five years was performed by materials of the Clinic of Forensic Medicine and Deontology, Sofia, Bulgaria. Ninety-five cases involve children from both genders. The traumatic injuries were carefully examined and classified according to their localization over the victim\'s bodies and based on the time that had passed after the reported assaults. In cases of sexual violence, the most informative and pointing at the exact type of violence are the injuries situated in the anogenital area. Too often, there is a lack of physical findings, depending on the type of sexual violence or associated with the prolonged time that passes after the crime. Children are unaware of what they have to do after suffering such traumas, or they are scared to share their experience with different family members, which can lead to late forensic examination and lack of physical and biological findings, which are the most critical traces in the criminal prosecution of the crimes and this can be a possibility for the perpetrator not to be charged for his unlawful actions.
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  • 文章类型: Case Reports
    自残是指一个人故意伤害自己,而无意自杀,但出于某种个人利益的动机。在当前的研究中描述了四个案例,具有四种不同的个人动机-药物供应,指控亲密伴侣暴力,父母禁令的对抗,以及一种隐藏和逃避犯罪的方法。当受害者具有一定程度的能力时,由于非典型病变和结构良好的虚假故事,评估自残造成的伤害可能具有挑战性。需要仔细分析受害者的故事,并对持续伤害进行彻底评估。如果存在对人工伤害的怀疑,需要立即咨询法医病理学家。
    Self-mutilation refers to the state in which a person deliberately hurts himself without the intention to commit suicide but with the motive of some personal gain. Four cases are described in the current study with four different personal motives - drug supply, accusation of intimate partner violence, confrontation of parental prohibition, and a way to hide and escape from a committed crime. Evaluating the injuries due to self-mutilation might be challenging due to atypical lesions and well-structured false stories when the victim has some level of competency. Careful analysis of the victim\'s story and a thorough evaluation of the sustained injuries are needed. If doubts about artificial injuries exist, immediate consultation with a forensic pathologist is required.
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  • 文章类型: Journal Article
    介绍法医科学不断发展,DNA分析技术的创新在提高刑事调查的准确性和可靠性方面发挥着关键作用。短串联重复(STR)一直是法医学的游戏规则改变者,提供独特的遗传标记来确定个人身份。这项研究探讨了STRDNA分析在非常规来源:咖啡杯中的应用。材料和方法在一项涉及16项无关的研究中,26至32岁的健康个体,从咖啡杯和口腔中调查DNA,将结果与之前的咖啡杯DNA研究进行比较。颊拭子提供了参考样本,风干10分钟,并储存在20℃。DNA定量显示,与参考相比,咖啡杯样品(0.015至0.049ng/μL)显着减少,阴性对照中没有DNA.一些STR基因座在研究样品中表现出抑制和较低的杂合性。伦理批准(REC53-592)和遵守赫尔辛基宣言确保了道德标准。这项研究强调了从各种来源获得有效DNA图谱的潜在挑战。结果不同杯型之间DNA浓度存在显著差异,陶瓷杯产生最高的浓度。此外,DNA分析结果从完整的概况,允许精确的个人识别,到部分剖面,这对决定性的比赛构成了挑战。这些发现对法医学具有深远的意义。这项研究证明了咖啡杯在刑事调查中作为DNA证据来源的潜力,即使获得了部分轮廓。这些证据可以帮助识别嫌疑人,受害者分析,并证实证人的证词.结论本研究突出了STRDNA分析在咖啡杯中的应用,为法医调查开辟了新的途径,并强调了在这个令人兴奋的领域继续研究和发展的必要性。这一观察结果与现有的从各种表面回收DNA的研究一致,需要进一步的研究来完善方法论,考虑使用模式,并解决有关从常见物体中收集和使用DNA证据的道德和法律问题。
    Introduction Forensic science has continually evolved, with innovations in DNA analysis techniques playing a pivotal role in improving the accuracy and reliability of criminal investigations. Short tandem repeats (STRs) have been a game-changer in forensic science, offering unique genetic markers to pinpoint individual identities. This study explores the application of STR DNA analysis to an unconventional source: coffee cups. Materials and methods In a study involving 16 unrelated, healthy individuals aged 26 to 32, DNA was investigated from coffee cups and mouth cavities, comparing the results to a previous coffee cup DNA study. Buccal swabs provided reference samples, air-dried for 10 minutes, and stored at 20°C. DNA quantification revealed a significant decrease in coffee cup samples (0.015 to 0.049 ng/μL) compared to the reference, with no DNA in negative controls. Some STR loci displayed inhibition and lower heterozygosity in the research samples. Ethical approval (REC 53-592) and adherence to the Declaration of Helsinki ensured ethical standards. This research highlights potential challenges in obtaining efficient DNA profiles from various sources. Results There was a significant variation in DNA concentrations among the different cup types, with ceramic cups yielding the highest concentrations. Moreover, the DNA profiling outcomes ranged from full profiles, which allow for precise individual identification, to partial profiles, which pose challenges for conclusive matches. These findings have profound implications for forensic science. The study demonstrates the potential of coffee cups as sources of DNA evidence in criminal investigations, even if partial profiles are obtained. Such evidence can assist in suspect identification, victim profiling, and corroborating witness statements. Conclusion This study highlights the application of STR DNA analysis for coffee cups, opening new avenues for forensic investigations and highlighting the need for continued research and development in this exciting field. This observation aligns with existing research on DNA recovery from various surfaces, and further research is warranted to refine the methodology, consider usage patterns, and address ethical and legal concerns regarding the collection and use of DNA evidence from common objects.
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  • 文章类型: Journal Article
    许多科学家对与COVID-19相关的隔离措施对人际暴力的影响表示担忧,主要涉及儿童和亲密伴侣,以及其他负面心理影响。在2020年初,希腊的自由流通被禁止42天,直到5月4日。我们研究的目的是调查移交给雅典国立和卡波迪兰大学医学院法医学和毒理学系的身体伤害指控案件的特征,希腊,在第一个月,在更广泛的阿提卡地区重新建立自由流通。我们还旨在通过比较2019年的相应时间段来发现有关身体伤害指控的任何可能差异。社区暴力(CV)指控的减少,尤其是青少年暴力事件,是在2020年观察到的。女性受害,以及对陌生人的指控,也减少了。没有观察到关于损伤机制的差异。2020年的受害者更快地提出指控,因此,比2019年的同行提前了近一天进行了检查。在封锁期间,家庭暴力(DV)热线报告显着增加,但矛盾的是,转诊到我们部门的DV病例减少了。在希腊,立法者没有预见到对试图逃避虐待的DV受害者的流通限制的任何具体豁免。我们的结果揭示了一个小的,但值得注意的是,对非致命人际暴力的影响。
    Many scientists expressed their concerns regarding the impact of COVID-19-related quarantine measures on interpersonal violence, mainly concerning children and intimate partners, as well as other negative psychological effects. During early 2020, free circulation in Greece was prohibited for 42 days, up until May 4th. The aim of our study was to investigate characteristics of bodily harm allegation cases referred to the Department of Forensic Medicine and Toxicology of the Medical School of the National and Kapodistrian University of Athens, Greece, during the first month succeeding free circulation re-establishment in the broader Attica region. We also aimed to detect any possible differences regarding bodily harm allegations by comparing the corresponding time period of 2019. A decrease in community violence (CV) allegations, especially youth violence incidents, was observed in 2020. Females\' victimization, as well as allegations against strangers, were also decreased. No differences were observed concerning the injury mechanism. Victims of 2020 filed the allegations faster and, thus, were examined almost one day earlier than their 2019 counterparts. During lockdown, domestic violence (DV) hotline reporting was significantly increased, but paradoxically DV cases referred to our Department were decreased. In Greece, the legislators did not foresee any specific exemption from circulation restriction for DV victims attempting to escape abuse. Our results revealed a small, but notable, impact on non-fatal interpersonal violence.
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  • 文章类型: Journal Article
    大多数身体暴力的受害者迟早会因为暴力而进入医院或医疗柜,尤其是急诊科(ED)。本文旨在通过审查开展的活动和报告的数据,分析急诊病房临床医生在此类受害者的法医管理中的表现。在大流行前的平均1年活动中,从米兰Policlinico的ED数据库中推断了991份医疗记录。对于每个医疗记录,对16个参数进行了深入分析,包括流行病学数据,关于暴力行动类型的信息,受伤,以及损伤发生和进入ED之间的时间。在绝大多数情况下,卫生专业人员忽略了所有具有法医学意义的行动,这不仅导致司法系统的数据丢失,而且特别是正确解释所发生的事情并采取适当措施保护患者/受害者的数据丢失。因此,鉴于ED的临床医生忙于非法医临床任务(这是正确的),应确保有专门的法医临床人员。然而,至关重要的是,当不幸的是没有法医人员时,至少在急诊室工作的临床医生接受了适当的培训,能够正确应用基本的法医学措施.总的来说,及时和知情的医学和法医干预对于改善和维护暴力受害者的身心健康是可能和必要的。
    Most victims of physical violence sooner or later will access a hospital or medical cabinet because of that violence, and in particular emergency departments (EDs). This paper aims to analyze the performance of emergency ward clinicians in the forensic management of such victims by examining the activities carried out and the data reported. A total of 991 medical records were extrapolated from the database of the ED of the Policlinico of Milan in an average pre-pandemic 1-year activity. For each medical record, 16 parameters were analyzed in-depth including epidemiological data, information on the type of violent actions, injuries, and time between the infliction of the lesion and access to the ED. In the vast majority of cases, all the actions with medicolegal implications had been neglected by health professionals causing loss of data not only for the justice system but especially for correctly interpreting what happened and taking appropriate measures to protect the patient/victim. Hence, given that clinicians in EDs are busy with non-forensic clinical tasks (and rightly so), it should be ensured that there be specific forensic clinical personnel. However, it is crucial that when unfortunately there can be no forensic staff, at least the clinicians who work in the ED are properly trained to correctly apply essential medicolegal measures. Overall, timely and informed medical and forensic intervention is possible and necessary for the improvement and maintenance of the mental and physical health of victims of violence.
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  • 文章类型: Journal Article
    未经评估:客观评估法医事件后发生的嗅觉功能障碍并不简单。嗅觉事件相关电位法,根据电生理记录,可以从法医学角度为评估创伤后失语症提供客观数据。这项研究,使用嗅觉事件相关电位测试对患有嗅觉感觉障碍的病例进行定量评估,旨在从法医学角度确定嗅觉功能障碍评估中应考虑的因素。
    UNASSIGNED:这项研究首先评估了98例因创伤后嗅觉受损而入院的患者的投诉,然后对患者进行了电生理气味测试。正因为如此,检查了病例的EEG反应与嗅觉障碍之间的关系。在参与研究的98例病例中,男性68人(69.4%),女性30人(30.6%)。在所有案件中,53人(54.1%)抱怨完全闻不到气味,14人(14.3%)抱怨气味减少,然而,除了现有的嗅觉功能障碍的投诉,其中44人(44.9%)有味觉障碍,18人(18.3%)有视力障碍。37例报告在测试过程中无法闻到气味的病例中有21例被证明是厌食。此外,16个案例指出,尽管在气味测试中有反应,测试后他们没有嗅觉。
    UNASSIGNED:尽管似乎可以证明与嗅觉事件相关的电位测试与无嗅觉症的诊断之间存在关系,关于其在临床实践中的使用仍在进行中的研究。一起执行主观和电生理测试以检测法医事件后发生的嗅觉功能障碍能够提供更可靠的诊断结果。
    UNASSIGNED: It is not straightforward to objectively evaluate the olfactory dysfunction that occurs following forensic incidents. The olfactory event-related potentials method, based on electrophysiological records, may provide objective data in the evaluation of posttraumatic anosmia cases from the medicolegal perspective. This study, where a quantitative evaluation of the cases with the complaints of olfactory sensation disorder was performed using the olfactory event-related potentials test, aims to identify the factors that should be considered in the evaluation of olfactory dysfunction from the medicolegal perspective.
    UNASSIGNED: This study first evaluated the complaints of 98 patients admitted because of posttraumatic impaired smell and then administered electrophysiological odor tests on the patients. Because of this, the relationship between the EEG responses of the cases and the olfactory disorder was examined. Of the 98 cases that participated in the study, 68 (69.4%) were male and 30 (30.6%) were female. Of all cases, 53 (54.1%) had complaints of not being able to smell at all, 14 (14.3%) had complaints of reduced smell, whereas, in addition to the existing complaints of olfactory dysfunction, 44 (44.9%) of them had complaints of taste perception and 18 (18.3%) reported having vision disorders. 21 of 37 cases who reported being unable to smell during the test turned out to be anosmic. Furthermore, 16 cases stated that, though having had a response in the odor test, they had no sense of smell following the test.
    UNASSIGNED: Although it seems possible to prove that there is a relationship between the olfactory event-related potential test and the diagnosis of anosmia, there is still ongoing research on its use in clinical practice. Performing both subjective and electrophysiological tests together to detect olfactory dysfunctions that occur after a forensic incident enable provide more reliable results in diagnosis.
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  • 文章类型: English Abstract
    Younger children in particular are at risk of becoming victims of dog attacks due to their small size. Such a biting incident can fulfil various criminal offences. In order to be able to satisfy possible legal claims, the injuries should be documented by forensic medicine and thus be legally binding. Therefore, close cooperation between the treating surgeons and forensic experts is recommended. A retrospective analysis of the cases of dog bite injuries in children and adults treated by clinical forensic medicine at the University Medical Center Rostock was carried out under various aspects. Adult casualties were predominantly injured on the lower extremities. The children examined were predominantly bitten on the head, neck and face region as well as the upper extremities. Injury severity ranged from skin redness to severe substance defects with loss of body structures. The biting dog was known in about half of the cases. In order to avoid dog bites in children, parents as well as children should be trained in dealing with dogs.
    UNASSIGNED: Insbesondere jüngere Kinder sind aufgrund ihrer geringen Körpergröße gefährdet, Opfer von Hundeangriffen zu werden. Ein solcher Beißvorfall kann verschiedene Strafbestände erfüllen. Um möglichen rechtlichen Ansprüchen genügen zu können, sollten die Verletzungen rechtsmedizinisch und damit gerichtfest dokumentiert werden. Es empfiehlt sich daher eine enge Zusammenarbeit von behandelnden ChirurgInnen und RechtsmedizinerInnen. Es wurde eine retrospektive Analyse der klinisch-rechtsmedizinisch bearbeiteten Fälle von Hundebissverletzungen bei Kindern und Erwachsenen an der Universitätsmedizin Rostock unter verschiedenen Aspekten durchgeführt. Erwachsene Verletzte wurden überwiegend an der unteren Extremität verletzt. Die untersuchten Kinder wurden überwiegend die Kopf‑, Hals- und Gesichtsregion sowie die obere Extremität gebissen. Die Verletzungsschwere reichte von Hautrötungen bis zu schweren Substanzdefekten mit Verlust von Körperstrukturen. Der beißende Hund war in gut der Hälfte der Fälle bekannt. Um Beißangriffe durch Hunde auf Kinder zu vermeiden, sollten Eltern sowie auch Kinder unbedingt im Umgang mit Hunden geschult werden.
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