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Difficulties in establishing a diagnosis of suicide
263
mentioned anions. The sodium salts were used in these experiments. In the assay systems, 1251-fibrin was used as a substrate. The clot was incubated for standardized periods with the solution to be tested and the amount of 1251-FDP in the liquid phase was determined. In the first assay system the fibrin clot was lysed extrinsically. This technique was found to be preferable in determination of the urokinase inhibitors in serum. In the second system, intrinsic fibrinolysis was applied. This was found to be advantageous in kinetic studies. Both methods have a good quantitative measure of the amount of lysed fibrin. Mathematical PETER
simulation
of gliding contusions
LijWENHIELM
A gliding contusion in the acute phase is characterized by a streaklike hemorrhage of venous origin situated subcortically in a paramedial convolution. In later stages perivascular necrosis may develop. This type of injury is caused by head angular acceleration and is often seen in traffic casualties when the head had hit the steering wheel, the dash-board or the windshield. The deformation of the brain matter close to the superior sagittal sinus has been simulated by means of a mathematical viscoelastic model in order to clarify the origin of the gliding contusions. The blood vessels in the brain matter will be strained as a consequence of the brain deformation which results from head angular acceleration. The highest values of the strain occur subcortically, where the blood vessels are injured first. The tolerance levels for gliding contusions have been determined. The calculations, which were based on experiments regarding the dynamic properties of the superior cerebral veins and on two alternative proposed injury criteria, indicate that a gliding contusion is not likely to arise if the maximal angular acceleration does not exceed 4500 rad/sec2 or the change in angular velocity does not exceed 70 rad/sec. Difficulties
in establishing
LARS-GUNNAR
a diagnosis of suicide
HijRTE
Forensic medicine should not be limited solely to the determination of causes of death. It should also attempt to outline general principles for the prevention of similar deaths and circumstances in the future. Since 1973 we have been studying the suicide problem in Uppsala. The results of our investigations show that before we can put forward any principles for suicide prevention, we have to improve the statistics especially the classification system - and the criteria for a diagnosis of suicide. In order to do this, (i) all suspected suicide cases should be sent to the Departments of Forensic Medicine; (ii) the criteria for diagnosis must be uniform. This is only possible if the physician concerned gets all available
264
information about the circumstances surrounding the death; (iii) the police as well as the physicians seem to be over-run with work, and therefore a person stationed at the Department of Forensic Medicine is needed, who should be responsible for collecting this information. Social and psychological analyses are often necessary; (iv) in order to improve the statistics, the classification must be made by the physician dealing with the case, using the ICD (International Classification of Diseases).
mentioned anions. The sodium salts were used in these experiments. In the assay systems, 1251-fibrin was used as a substrate. The clot was incubated for standardized periods with the solution to be tested and the amount of 1251-FDP in the liquid phase was determined. In the first assay system the fibrin clot was lysed extrinsically. This technique was found to be preferable in determination of the urokinase inhibitors in serum. In the second system, intrinsic fibrinolysis was applied. This was found to be advantageous in kinetic studies. Both methods have a good quantitative measure of the amount of lysed fibrin. Mathematical PETER
simulation
of gliding contusions
LijWENHIELM
A gliding contusion in the acute phase is characterized by a streaklike hemorrhage of venous origin situated subcortically in a paramedial convolution. In later stages perivascular necrosis may develop. This type of injury is caused by head angular acceleration and is often seen in traffic casualties when the head had hit the steering wheel, the dash-board or the windshield. The deformation of the brain matter close to the superior sagittal sinus has been simulated by means of a mathematical viscoelastic model in order to clarify the origin of the gliding contusions. The blood vessels in the brain matter will be strained as a consequence of the brain deformation which results from head angular acceleration. The highest values of the strain occur subcortically, where the blood vessels are injured first. The tolerance levels for gliding contusions have been determined. The calculations, which were based on experiments regarding the dynamic properties of the superior cerebral veins and on two alternative proposed injury criteria, indicate that a gliding contusion is not likely to arise if the maximal angular acceleration does not exceed 4500 rad/sec2 or the change in angular velocity does not exceed 70 rad/sec. Difficulties
in establishing
LARS-GUNNAR
a diagnosis of suicide
HijRTE
Forensic medicine should not be limited solely to the determination of causes of death. It should also attempt to outline general principles for the prevention of similar deaths and circumstances in the future. Since 1973 we have been studying the suicide problem in Uppsala. The results of our investigations show that before we can put forward any principles for suicide prevention, we have to improve the statistics especially the classification system - and the criteria for a diagnosis of suicide. In order to do this, (i) all suspected suicide cases should be sent to the Departments of Forensic Medicine; (ii) the criteria for diagnosis must be uniform. This is only possible if the physician concerned gets all available
264
information about the circumstances surrounding the death; (iii) the police as well as the physicians seem to be over-run with work, and therefore a person stationed at the Department of Forensic Medicine is needed, who should be responsible for collecting this information. Social and psychological analyses are often necessary; (iv) in order to improve the statistics, the classification must be made by the physician dealing with the case, using the ICD (International Classification of Diseases).