Forensic gynaecology

To put a patient at ease is always important, but this is especially so when making an examination following a sexual offence. The place of examination is important. The choice can be a police station, a hospital or your own consulting-room. If at all possible, your own consulting-room is best. Always explain exactly what you are doing and for what reason. This is reassuring to the patient. Take the specimens systematically. Number and label them carefully before handing them over to the police officer. Notes taken at the time of your examination can be used when giving evidence in court. Therefore legible notes are invaluable. I have also found it useful to have a photostat of my statement as a witness. The police will provide this on request. Note-taking is particularly important in cases in which there are special difficulties. Examinations following sexual assault involve attending court to give evidence. By no means all the examinations made will lead to court cases. Often the accused cannot be found, sometimes the woman drops the allegation, or the Director of Public Prosecutions does not recommend the case to come for trial. Since the Criminal Justice Act 1967 it has been possible in all criminal proceedings to admit a written statement as evidence just as if it had been given orally. This statement must be signed by the witness, who will be liable to prosecution if he has stated in it anything that he knew to be false or did not believe to be true. A copy is served on the opposing side and if they make no objection it can be used by the defence in evidence. In other words, your presence in court is necessary only if some point needs to be made clear by cross-examination. I should like to see long-term follow up of rape victims. At present there is none that I know of, but at least some immediate reassurance and explanation can be given to the patient, together with treatment and recommendations for further care if necessary.

Arsenic poisoning from anti-asthmatic herbal preparations

Arsenic poisoning, a disease of the past, was recently found in 74 patients in Singapore over a 15-month period. Most victims (70%) had a chronic form of poisoning and 64% of the cases were caused by a local anti-asthmatic herbal preparation containing 12,000 ppm of inorganic arsenic sulphide. The other patients were poisoned by six other brands of herbal preparations used for the treatment of asthma and a variety of other illnesses. Subsequent investigations revealed another 22 other brands of Chinese herbal preparations containing high concentrations of inorganic arsenic ranging from 25 to 107,000 ppm, of which most were imported. Nearly 40% of the patients had taken the medicine for less than six months, but the others had a longer history of exposure ranging from one to 15 years. Systemic involvement was confined mainly to the skin (91%), nervous system (51%), gastrointestinal system (23%) and blood (23%). Malignancy of the skin was present in six patients, and of the visceral samples, toxicological confirmation was found in half of the cases investigated. There was no correlation between the clinical status of the patients and their tissue arsenic content. The importance of arsenic poisoning by herbal preparations is discussed, as there are no known reports of their association.

[Nail changes and loss of hair: cardinal signs of mercury poisoning from hair bleaches (author's transl)]

In the German Federal Republic it has recently become known that generalised disorders of chronic mercury poisoning (loss of weight, stomatitis, hearing and sensory loss, emotional disturbances) have accompanied the cardinal signs of nail discolouration and loss of hair. The mercury content of nails in such patients was extremely high (1720 mg/l). The urinary level of mercury after dimercaprol injection was 1.97 mg/l, about 400 times above the upper limit of normal (0.005 mg/l). The poisoning was apparently caused by the use of mercury-containing bleaches (about 5% and 6% Hg) which do not require prescription and are marketed without any statement about composition or possible side-effects. The cases are a warning against uncontrolled use of external application of mercury-containing preparations.

A genetic electrophoretic variant of human hair alpha polypeptides

The structural proteins of hair were solubilized by reduction of disulfide bonds in 6 M urea at alkaline pH. Following conversion of the proteins to the S-carboxy-methyl derivatives, disc electrophoresis was done in 6 M urea at pH 8.3. In about 5% of the individuals studied, a variation in the normal electrophoretic pattern was observed, and this was true of hair from different body sites. An autosomal dominant mode of inheritance was found in the four families investigated. The variant pattern was not associated with any detectable change in the color, shape, stree-strain characteristics, X-ray diffraction pattern, or amino acid composition of the hair. A similar variant pattern was also observed in nail. The most likely hypothesis is that there is a polymorphism of one of the alpha polypeptides, although a mutation of a rate-determining gene cannot be excluded.

A comparison of concentrations of lead in human tissues

This postmortem study of lead concentrations in the tissues of 129 subjects is an extension to a report by Barry and Mossman (1970). Lead concentrations in bone greatly exceeded the concentrations in soft tissues and were highest in the dense bones. Bone lead concentrations increased with age in both sexes, more especially in male subjects and in dense bone, varying between mean values of 2-16 ppm in the ribs of children to over 50 ppm in the dense petrous temporal bones of elderly male adults. Male adults contained over 30% more lead in their bones than females. Mean concentrations of lead in the soft tissues varied from less than 0-1 ppm in organs such as muscle and heart to over 2 ppm in the aorta. In most tissues with lead values in excess of 0-2 ppm the male concentrations exceeded female values by about 30%. With the exception of the aorta, spleen, lung, and prostate, lead concentrations did not increase with age in the soft tissues of either sex after about the second decade of life. Children showed concentrations of lead in their soft tissues comparable to female adults, but the concentrations in bone were much lower. It is suggested that children do not possess the same capacity as adults to retain lead in bone. In male adults occupationally exposed to lead the concentrations of lead in bone exceeded the concentrations in unexposed male adults within the same age group by two-to three-fold. Soft tissue lead concentrations between the two groups were less divergent. An assessment of the total body burden of lead revealed higher levels in adult male subjects than in females at mean values of 164-8 mg compared to 103-6 mg, respectively. Over 90% of the total body burden of lead in adults was in bone, of which over 70% was in dense bone. Male adults occupationally exposed to lead had mean total body burdens of 566-4 mg Pb, of which 97% was in bone. The release of lead from bone in conjunction with calcium was not considered to be of physiological significance. Lead concentrations of hair and nails were higher than soft tissue lead concentrations and varied widely. Hair lead measurements were not considered to provide a reliable assessment of lead absorption. The concentrations of lead in tissues of a mixed group of subjects with no known occupational exposure to lead have been shown to be comparable to the findings in earlier studies. Present levels of lead in the environment are not considered to be a hazard to the health of the population in general.

Quantitation of gold in skin in chrysiasis

Skin, plasma, hair, and nail gold levels were determined in three groups of patients with rheumatoid arthritis comprising: I. Three patients on long term gold therapy exhibiting altered skin pigmentation (chrysiasis); II. Five patients on long term gold therapy exhibiting normal skin pigmentation; III. Two patients starting gold therapy. Group I had higher skin gold levels (50-140 mug/g) than Group II (7.5-13 mug/g) while Group II had minimal levels. Hair and nail gold levels were not much higher than gold levels in non-gold treated individuals. The possible role of skin in the storage or excretion of gold is discussed.

Arsenic intoxication as a cause of megaloblastic anemia

We have described a case of chronic arsenic intoxication associated with pancytopenia and megaloblastic erythropoiesis. The patient had the typical laboratory manifestations of effective erythorpoiesis due to a megaloblastic process, including macroovalocytes, mild pancytopenia, low reticulocyte index, increased marrow cellularity with erythroid hyperplasia, and morphologic evidence of megaloblastic maturation in the marrow. The patient's serum folate and vitamin B12 were normal, and the anemia regressed without therapy. Our case suggests that the combination of megaloblastosis with normoblastic or megaloblastic karyorrhexis,should raise the suspicion of arsenic intoxication in the mind of the observer. In addition, arsenic should be added to the list of agents causing a reversible megaloblastic anemia.

Sodium, calcium, and magnesium levels in nails of children with cystic fibrosis of the pancreas

Nail sodium, calcium, and magnesium levels were measured in 15 children with cystic fibrosis (CF) of the pancreas and compared with values found in 78 controls. There was a significant increase in the mean value of all three parameters in the CF group. There was an overlap in the values between the affected and control groups for all three measurements. Summing the sodium and calcium values or the sodium, calcium, and magnesium values gave a clear-cut separation between the groups, this being better in the latter case. It is felt that this approach might also prove fruitful in the detection of the heterozygote.

Occurrence of ungulic acid in some epidermal tissues

The lipids isolated from different animal tissues have been studied qualitatively, by TLC, for the occurrence of the ungulic acid fraction. This fraction was found in considerable amounts only in epidermal tissues and its keratinized derivatives. In the present study it was isolated from human keratinous epidermis, hair, and nails, pig bristles, wool, and feathers. The analytical results indicated that a lipid fraction from all of these sources contained ceramide, galactose, galactosamine, sulfate, and sialic acid in equimolar amounts, and that the fractions were similar to the ungulic acid isolated earlier from a horse's hoof.