مجله پزشکی قانونی
سال یازدهم شماره 1 (پیاپی 37، بهار 1384)

Excessive occupational noise exposure is a major cause of hearing impairment in workers inindustrial settings. Textile industry with different machines is considered as a noise producer industry. In this study, sound analyzing and measurement performed for spinning and weaving machines used in a textile plant in the city of Semnan (1997). All noise-exposed workers with at least 5 years work record, as the test group (n=70) completed audiometry and their results compared with non-exposed administrative personnel (n=30). The results showed that average sound level of all spinning and weaving machines were higher than 85 dBA, except for two cotton beating machines. Weaving machines had higher sound pressure level than spinning machines in all octave bands (63-8000 Hz). Sensory hearing loss was more prevalent in the test group in spite of less mean age and work record than control group. Only 20% of the workers sometimes used earplugs as Hearing Protection Device (HPD). Based on this study and previous researches, it is concluded that gross occupational noise exposure is a common and serious problem in industrial mills in Iran.

The accuracy of nocturnal penile tumescence monitoring was compared to penile duplex ultrasonography, cavernosography and pharmaco-infusion cavernosometry in diagnosis of erectile dysfunctions. Nocturnal penile tumescence was evaluated in 68 patients as normal or abnormal according to standard general criteria. The results were compared to penile duplex ultrasonography parameters (peak systolic velocity, normal greater than 35 cm. per second, and diastolic velocity, normal less than 5 cm. per second), and to the flow rate needed to maintain erection (normal less than 15 ml. per minute) with pharmaco-infusion cavernosometry. Of the 68 patients 36 had normal nocturnal penile tumescence, including 34 (94.5 percent) with normal penile systolic velocity, 28 (78 percent) with normal penile diastolic velocity and 32 (89 percent) with normal flow to maintain erection. On the other hand, 32 men had abnormal nocturnal penile tumescence of whom 7 (29 percent) had abnormal penile blood flow velocity, 22 (69 percent) had abnormal diastolic flow velocity and 24 (75 percent) had high flow rate to maintain erection. Normal nocturnal penile tumescence appears to correlate well with normal systolic blood velocity and cavernosometry but poorly with diastolic blood velocity. On the other hand, a low correlation exists between abnormal nocturnal penile tumescence and abnormal diastolic blood flow or abnormal cavernosometry. Furthermore, no correlation exists between abnormal nocturnal penile tumescence and abnormal systolic blood flow. According to this observation we presume that nocturnal penile tumescence, penile duplex and infusion cavernosometry and cavernosography should be performed to achieve a reasonably accurate diagnosis.

Unexpected sudden death (USD) during or immediately after extreme excitation is an unsolved problem in medicine and sometimes problematic in judicial action. The purpose of this study is to identify and determine some risk factors and co-existing (co-morbid) illnesses in SUD. This is a descriptive and case series study. Forty cases of sudden unexpected death during or soon after nontraumatic quarrels, were evaluated in Isfahan and Tehran Forensic Medicine Centers according to their clinical history, macroscopic, microscopic and toxicological findings during a five year period (from 1377 to 1382). Forty percent of cases were between of 35-45 years old. Death was more common in men (90%). History of cardiovascular and psychiatric diseases was positive in 20% and 22.55% respectively. Thirty-five percent of cases had had positive history of substance abuse: cigarette, opium and alcohol were the most common substances used but cocaine or amphetamine was not found in any case. Five percent of cases had positive family history of sudden unexpected death. According to this study it seems that the SUD following extreme excitation had independent factors (other than the threshold of vulnerability due to excitation in each person), although the presence of history of cardiovascular diseases had a positive and direct correlation with SUD.

Diagnosis of abortion due to trauma is one of the important duties of physicians. In this study the relation between trauma and abortion is discussed to find an appropriate strategy for physical cases. This has been a prospective correlational study, 50 pregnant women who had trauma to abdomen followed by abortion were observed. They were referred to observation department of central legal medicine organization with in a period of 8 months. The findings were analyzed by SPSS. Most of cases were between 25-30 y/o. of which, 36 patients (72%) were from Tehran and 14 (28%) from elsewhere. They were often housekeeper and their education was highschool graduate or less. History of abortion in 5 patients (10%) was positive and 6 patients (12%) had familial marriage average gestational age of 13/8 week. There was evidence of trauma (injury) to abdomen and pelvic region in 6 patients (12%) and to other parts of body in 25 patients (50%). Vaginal bleeding because threatened abortion was seen in 33 patients 66%) in which 31 patients had vaginal bleeding before 24 hours and 2 patients after 24 hours following the truama. Relation between trauma and abortion in 14 patients (28%) was confirmed. 21 patients 42%) had not reliable history. Only 15 patients (30%) had sign of threatened abortion and evidence of trauma without abortion Physical trauma to pregnant women can lead to abortion and preterm labor If: 1) Trauma is severe 2) Manifestations of threatened abortion are present immediately after trauma.

Pregnant women’s population is important from the point of view of health indices. Their mortality means low health index and this is a great problem. On the basis of WHO report, every year 600000 women die because of complications of pregnancy and delivery. That is 1600 women die every day and one woman every minute. Since definite cause of death is aften determined by post mortem autopsy in forensic medicine center, we decided to evaluate cases referred to legal medicine center to determine causes and risk factors of maternal death. We hope to find ways to prevent and solve this great problem. This was a descriptive and cross sectional study. The studied population consisted all cases of pregnant women who had died during pregnancy or delivery (in 1999-2005) and were referred to legal medicine center of Khorasan province. According to the data gathered through completed forms seventeen cases were evaluated. Results & Range of maternal mortality age was 17-41 and the average was 31.2 years. Most of them occurred in the 3rd trimester, while 41.2% were primipara and 17.7% were grand multipara. The most common cause of death determined by their physician was amniotic fluid emboli (35.3%) and by forensic physician was hemorrhage (41.2%) which agreed in 64.9% and not in 35.4% of cases. Finally causes of maternal death were hemorrhage, AFE, ecclampsia, infection and other. In 41.2% surgical intervention to save the patients’ life was done and in 58.8% it was not necessary. Type of delivery in 64.9% of cases was Cesarean section and in 29.4% was vaginal. Factors that influenced maternal mortality were inexpertness (41.3%), absence of blood bank (23.6%), unavailability of expert physician and absence of medical equipments (both: 17.6%).

Intrauterine fetal death is one of the problems in obstetrics which could be prevented by good prenatal care and prompt diagnosis and treatment in most of the times. The aim of this study is to investigate the etiologic factors which cause intrauterine fetal death Two hundred cases of intrauterine fetal death were diagnosed and etiologic factors were investigated 51.7% of intrauterine fetal deaths occurred in the 2nd trimester and 48.3% occurred in the 3rd trimester. Mean maternal age was 28.4 ± 6.4 years. Sixty six percent point five of mothers had 1-3 pregnancies; 39.6% of mothers had previous abortion. Systemic diseases were present in 29.9% of mothers. Mean fetal age was 29.6 ± 6.5 weeks. 84.2% of dead fetuses had no anomalies and 9.3% had fetal anomalies. 56% of dead fetuses were male, 38.4% were female and 5.6% had no definite sex. No fetal death was diagnosed due to Rh incompatibility. Placental abruption was present in 6.9% of cases. Maternal use of drugs was seen in 20.1% We can prevent intrauterine fetal death in most cases, especially when there are no fetal anomalies.

Gender Identity Disorder (GID) is a strong and persistent cross gender identification and persistent discomfort with his or her sex. Those extreme forms of GID involve attempts to simulate phenotype of the opposite biological sex. Nowadays treatment of GID is complex and rarely successful when the goal is to reverse the disorder. Psychotherapy prepares patients to deal with their disorder, not to alter it. This case series presents 4 cases of GID that were treated successfully. A 16 year old male, a 19 year old male, a 18 year old female and a 20 year old female have been treated for 4-6 months successfully by weekly psychotherapy. Successful treatment of these cases shows the efficacy of non hormonal and nonsurgical treatment of GIDs, and discourages premature sex reassignment surgery.

It is always necessary to have a minimum level of cultural knowledge for every one who wants to enjoy common rights of a society, and then all members of a society can be asked to obey lows and regulations. Medical ethics, as one of the most applicable branches of ethics, has always been interesting for ethicists. It has always been intertwined with medical principles and rules. And since promoting the effects of physician’s medical knowledge on patient’s health through psychological and moral principles is a research topic in medical ethics, practitioners of these principles, namely physicians, have always shown much interest in it. Medical ethics is a social science that provides solutions for ethical dilemmas arising from medical practice. The present paper is an attempt to relate these principles with Islamic general ethical principles and rules.