مجله پزشکی قانونی
سال دوازدهم شماره 4 (پیاپی 44، زمستان 1385)

Self harm is a deliberate,impulsive and nonfatal action that hurts person’s body and appears in different forms.The most widespread forms are injury or rupture of tissues,that called self mutilation. Self mutilation is seen in the varieties of mental or personality disorders. However some mutilate themselves for purpose of reparations or prosecution.This group are refered to forensic medicine.This research is done for detection of personality characteristics of the recent group. Fifthy clientele were diagnosed as self mutilation in Forensic Medicine Center and fifthy quarreller and fifthy vehicle accidental, were selected by simple random sampling and assessed by shortform type of MMPI (71items). Finally there are significant difference between self mutilation group and accidental group in scale of Hs or hypochondriasis (P=0.032), Hy or hystery (P=0.030) and Pa or paranoia (P=0.007), but there isn’t any difference with quareller group. Based on the results, self mutilators that referred to Forensic Medicine Centers have following characteristics: They are egoist and narcissit. They project their anger and hostility to the others. They criticize others. For their own sabotage, they culpable the others. They are superficial in their social relations. They need the others’ attention and emotional support. They use their body for attract the others’ attention and for influence the others. They don’t show anxiety and depression disorders.

Violence against health staff is a widespread problem occurring in different ways and has multiple consequences on health personnel, health systems and even patient care. Emergency Department (ED) personnel especially nursing staff have a higher risk of being exposed to violence, but due to the lack of any recording and reporting system of such incidents, the history of related studies in our country is limited. This exploratory study was conducted in EDs of three major hospitals of Tehran University of medical sciences in 2004, in order to determine the frequency of violence against nursing staff.

Data of this cross sectional study were retrieved by questionnaire from 136 nurses working in the ED of three hospitals, Imam-Khomeini, Shariati and Sina. The questionnaire consisted of questions on sociodemographics, previous experience of different types of violence and its reporting. Data were analyzed using statistical software (SPSS) version 11.5.

Of study participants, 66.9% were female and 31.6% were male. The overall experience of violence was rather high (98.6%): 97.8% verbal violence, 39.7% physical violence and 86% other types of violence. Reporting of physical violence was more than the other types. The reasons of underreporting of violence according to the participants were belief in inefficacy of any actions in this regard and their intentions for not magnifying the incident in the workplace. Most of the nurses believed that the possible explanations for the violence incidents they faced were prolonged waiting time in ED, high direct costs, inadequate health insurance, and finally inadequate number of personnel in ED. A majority of nurses had worries about being assaulted in the ER in the future (91.1%).

Exposure to violence especially verbal violence among nurses working in EDs is high, but despite the high prevalence of worrying about reoccurrence of violence, most of the cases remain unreported and don’t result in a legal action. It seems that arrangement of systematic educational courses concerning prevention of violence and conflict resolution for ER staff, empowerment of security systems like guards, adoption of strategies to support assaulted staff and take effective legislative actions against aggression and violence in the health systems may be effective to reduce the burden problem.

Nontraumatic subarachnoid hemorrhage is a neurologic emergency, which has a high rate of death and complications and its risk factors are preventable to some extent. Aim of this study is to investigate: risk factors, epidemiology, manifestations of disease and distinction between NSH and traumatic subarachniod hemorrhage. This study is a descriptive research based on 26 persons died due to aneurismal subarachniod hemorrhage in 2005-2006 send to Legal Medicine Organization of Tehran. Variables such as age, sex, duration from initiation of disease until death, manifestation of disease, type, location, amount and source of bleeding and also risk factors which are all investigated with autopsy and interview will relatives and studying clinical reports. Among 26 persons died due to aneurismal subarachnoid hemorrhage, 69% were male, 31% were female, and mean age was at 47 years. The most common symptoms on the onset of disease were sudden onset of severe headache and loss of consciousness. 73% of them died within 24 hours after the event. 62% had a history of hypertention, 42% did cigarette smoking, 35% were exposed to sever excitations, 19% had a history of headache. In all cases, there was subarachnoid hemorrhage, 31% with intraventricular bleeding, 8% with intra cerebral hemorrhage. Although in 25% of cases determining the position of rupture was impossible as a result of bleeding severity, clot around vessels and brain death a few day before autopsy, in 40% of cases bleeding had happened in anterior part and in 35% of cases in posterior part of Williss cycle. It seems that serious intervention for reducing risk factors such as cigarette smoking, hypertention and sever excitation can reduce risk of rupture of an intracranial aneurysm. Rate of death within 24 hours of the onset of disease was extremely more than other countries. More researches should be done about transporting duration of patients to medical centers, determining the amount of primary bleeding, rebleeding, vasospasm and efficiency of treatment.

The aim of this study is the report of our experience in diagnosis of the opium body packers with CT scan. For 12 cases that confessed to opium packet ingestion, we did abdominal and pelvic CT scan without contrast and evaluated the presence, number and location of opium packets and also measured the density of packets in Hounsfield unit(HU). Mean age of our cases was 28.2±5.9 years (ranging 17 – 35 years). Eleven (91.6%) of patients were male and only one case was female. In all patients, the packets were visualized in gastrointestinal (GI) lumen by CT scan. The mean of minimum HU was 163.8±19.6 and the mean of maximum HU was 205.3±32.8. We had mortality in an eighteen years old female due to opium overdose. CT scan could be a suitable imaging modality in identifying opium packets similar that reported for cocaine and heroin.