Archiv Fur Kriminologie[JOURNAL]
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200 papers
Fatal bleeding from an aortocoronary bypass.
Ortmann J, Doberentz E, Mdhle F … +1 more , Madea B
Arch Kriminol · 2017 Mar · PMID 29870183
Coronary bypass grafting is a routine procedure in heart surgery, which can now also be performed using a minimally invasive technique on the beating heart. In the presented case, a 55-year-old man died two days after by...
Coronary bypass grafting is a routine procedure in heart surgery, which can now also be performed using a minimally invasive technique on the beating heart. In the presented case, a 55-year-old man died two days after bypass surgery. His condition had deteriorated post-operatively over 2 days until he finally died from multi-organ failure and cardiogenic shock. Autopsy revealed a fatal haemorrhage into the chest cavities from a small tear in the bypass and acute myocardial infarction. The haemorrhage had not been noticed in the hospital. Postoperative haemorrhage is a common complication after this type of surgery, which occurs in about 1-2 % of cases.
Interdisciplinary teaching and training - A medicolegal specialty.
Parzeller M, Amendt J, Zehner R … +4 more , Toennes SW, Kettner M, Bratzke H, Verhoff MA
Arch Kriminol · 2017 Mar · PMID 29870182
The Frankfurt model is described to exemplify the teaching and training concepts implemented at the Institute of Legal Medicine in Frankfurt am Main up to 2015. The Frankfurt model describes a comprehensive, networked te...
The Frankfurt model is described to exemplify the teaching and training concepts implemented at the Institute of Legal Medicine in Frankfurt am Main up to 2015. The Frankfurt model describes a comprehensive, networked teaching system aiming at an interdisciplinary training. Interdisciplinarity is a domain of forensic medicine as a broadly diversified subject related to various scientific disciplines. The importance of the medicolegal triad (research, teaching, services) rooted in the university setting, on which the success of this interdisciplinary teaching and training concept is based, is illustrated. Sufficient funding is required to maintain this medicolegal triad, and the consequences of potential reductions due to fiscal reasons are outlined.
Suicide by stabbing while driving a car.
Ortmann J, Doberentz E, Gerhard KW … +1 more , Madea B
Arch Kriminol · 2017 Mar · PMID 29870181
Complex suicides represent only a small number of all suicides. The case of a 27-year-old man who drove his car against a tree is presented. The emergency physician diagnosed a stab to the thorax. A kitchen knife was fou...
Complex suicides represent only a small number of all suicides. The case of a 27-year-old man who drove his car against a tree is presented. The emergency physician diagnosed a stab to the thorax. A kitchen knife was found on the rear seats of the vehicle. Autopsy revealed death by exsanguination due to perforation of the left cardiac ventricle. Blunt force injuries caused by the collision were also found.
Case report on the feasibility of determining the compatibility between mandible and skull by morphological examination.
PreiBler S, Kauferstein S, Niess C … +2 more , Verhoff MA, Kolzer SC
Arch Kriminol · 2017 Mar · PMID 29870180
When human bones are found it is important to establish whether they belong to one or more individuals. Osteological examinations assessing morphological characteristics provide an important tool, in particular for a fir...
When human bones are found it is important to establish whether they belong to one or more individuals. Osteological examinations assessing morphological characteristics provide an important tool, in particular for a first appraisal. In the reported case, an isolated, toothless mandible that had been found in a river appeared to be too large to match a skull found in the same context. Moreover, shortly before and after the mandible had been found, two headless corpses had been recovered from the same river. The initial conclusion was, therefore, that the mandible and the skull belonged to different individuals. Forensic DNA-testing confirmed, however, that the mandible, the skull, and one of the bodies were from the same individual, who could later be identified through DNA comparison with two biological children. So far, current knowledge has only been that mandibles may erroneously be considered too small by morphological assessment to be compatible with a found skull, as reported in a paper by Reichs (1989). The reported case establishes that the opposite phenomenon may also occur. The findings show that more extensive studies investigating the correlation between mandible and cranial base in a moden population seem to be necessary.
[Homicide-suicide, double suicide or homicide followed by suicide 2 case reports].
Stockhausen S, Wollner K, Mohle F … +3 more , Doberentz E, Kernbach-Wighton G, Madea B
Arch Kriminol · 2017 Mar · PMID 29870179
Cases in which several persons who died from an unnatural cause are found together are often difficult. It is necessary to exclude homicide committed by another person and to clarify whether the deaths are the result of...
Cases in which several persons who died from an unnatural cause are found together are often difficult. It is necessary to exclude homicide committed by another person and to clarify whether the deaths are the result of a homicide-suicide or a joint suicide of persons wishing to die. Two cases in which couples with gunshot wounds to the head had been found lifeless in their homes are presented. In both cases, the deceased were of advanced ages and suffered from severe pre-existing diseases. Due to the circumstances at the scene, the results of the investigations and the autopsies as well as the suicide notes found, a double suicide was assumed in both cases. The husbands killed themselves after shooting their wives. Based on the presented cases the so-called double suicide and the need for a thorough investigation of the death scene with the problem of differentiating it from homicide-suicide and double homicide are discussed.
Deaths in Hamburg prisons 1996-2012 - Recommendations on suicide prevention in prison custody.
Petersen J, Kunze S, Thiel A … +3 more , Fiedler G, Briken P, Puschel K
Arch Kriminol · 2017 Mar · PMID 29870178
130 cases of prisoner deaths in Hamburg were examined in a doctoral thesis providing the basis for this study (P e t ers en 2016). Compared with previous assessments, prisoners live longer and are slightly more likely to...
130 cases of prisoner deaths in Hamburg were examined in a doctoral thesis providing the basis for this study (P e t ers en 2016). Compared with previous assessments, prisoners live longer and are slightly more likely to die of natural causes, the most common cause of death being heart attack. Also, medical care in prisons has significantly improved - some prisoners in fact receive better treatment while incarcerated as compared to outside of prison. The suicide risk, however, remains 8 times as high for inmates compared to the general population. 55 % of these suicides take place within the first 30 days of pre-trial detention. Most of the suicides in Hamburg prisons (26 %) occur on Sundays. In previous studies this number was lower at 15 % (Granzow 1996) and nationwide it was at 20 % (Bennef eld-Kersten 2012). The paper also provides 18 recommendations to prevent future suicides of prisoners. Overall, the rate of prison suicides is slightly decreasing. Prisoners today live longer and mostly die of lifestyle diseases, particularly heart attacks. However, they are still significantly more likely to take their own life than individuals living in freedom.
[A case of acrania?].
Möhle F, Jan O, Müller AM … +2 more , Kernbach-Wighton G, Madea U
Arch Kriminol · 2017 Jan · PMID 29791115
The article reports on the case of a premature and stillborn child. As a first step it had to be clarified whether the child had been alive. The pathological examination of the placenta performed after autopsy could prov...
The article reports on the case of a premature and stillborn child. As a first step it had to be clarified whether the child had been alive. The pathological examination of the placenta performed after autopsy could prove a retroplacental hematoma as the cause of death. Furthermore the autopsy revealed a severe skull deformity that would probably have made the survival of the child impossible.
[Stature estimation from teeth and jaw].
Gille R, Ramsthaler F, Thali M … +3 more , Strunk J, Birngruber CG, Verhoff MA
Arch Kriminol · 2017 Jan · PMID 29791114
After the discovery of skeletonized human remains, the estimation of stature is an important element of the so-called "biological profile". Typically, long bone lengths are used in regression formulas. If long bones are...
After the discovery of skeletonized human remains, the estimation of stature is an important element of the so-called "biological profile". Typically, long bone lengths are used in regression formulas. If long bones are not available, predictions of stature cannot be made. Human skulls are often the subject of forensic osteological examination, sometimes even detached. Therefore, it seems reasonable to search for skull measurements that have a sufficiently good correlation to stature. The aim of the study presented was to measure odonto-stomatological parameters using post-mortem CT data to check whether the esti- mation of stature was possible on this basis. Three classic tooth dimensions (MD, BL, ZL), two diagonal tooth dimensions (MBDL, DBML) first described by Lund and Mörnstad in 1999, two tooth dimensions defined for the first time in this study (MKDO, DKMO), the mesiodistal index (MDS) and also the palatal arch dimensions (arch length, arch width, molar length and dental length) - each at maxilla and mandible - were digitally measured on a total of 799 teeth of 48 virtual 3-D-reconstructed skulls (33 males and 15 females). For most of the aforementioned measurements no statistically significant relation to stature was found. There were positive correlations by Pearson at a significance level of 99 % (2-sided) at three measurements: ZL 15, MKDO 14 and MKDO 15. Positive correlations by Pearson at a significance level of 95 % (2-sided) could be determined for eight measurements, but an applicable regression formula could not be calculated for any of the parameters. Despite a statistical correlation of a few teeth parameters with body length, they must be considered unsuitable for estimating stature.
[Rare causes of iatrogenic pericardial tamponade - 2 case reports].
Stockhausen S, Kernbach-Wighton G, Madea B … +1 more , Doberentz E
Arch Kriminol · 2017 Jan · PMID 29791113
Two rare causes of iatrogenic pericardial effusions are presented. In the first case, a 61-year-old woman who had undergone laparoscopic surgery for a diaphragmatic hernia was resuscitated without success the next day. A...
Two rare causes of iatrogenic pericardial effusions are presented. In the first case, a 61-year-old woman who had undergone laparoscopic surgery for a diaphragmatic hernia was resuscitated without success the next day. As cause of death circulatory failure as a result of post-operative pulmonary embolism was reported. Autopsy results showed that the pericardium and the heart had been sewn to the diaphragm. The suture was torn from the tissue, which caused a hemorrhage into the pericardium and the chest cavity, so that death was diagnosed to be due to cardiac tamponade and hemothorax after an iatrogenic heart injury. In the second case, a 62-year-old man who had developed a massive incisional hernia after treatment of an abdominal gunshot wound underwent open herniotomy with mesh repair. Postoperatively, the man complained about increasing pain and shortness of breath. He was transferred to another hospital for further assessment, where a cardiac tamponade was diagnosed. Autopsy results showed that three of the plastic staples used to fix the mesh had perforated the diaphragm and the pericardium thus injuring the adjacent right ventricle with subsequent perforation and development of a hemopericardium.
[Drinking study on the pharmacokinetics of the grappa congener 2-butanol].
Wunder C, Rohde R, Trageser P … +2 more , Paulke A, Toennes SW
Arch Kriminol · 2017 Jan · PMID 29791112
A drinking study on the pharmacokinetics of the typical grappa congeners 2-butanol and 2-butanone (methyl ethyl ketone) was performed. It was expected that the concentration ratio might provide a means to estimate the ti...
A drinking study on the pharmacokinetics of the typical grappa congeners 2-butanol and 2-butanone (methyl ethyl ketone) was performed. It was expected that the concentration ratio might provide a means to estimate the time of ingestion of a grappa beverage. Twelve subjects drank a volume of the grappa "Vecchio di Prosecco" (42 vol%) to reach a blood alcohollevel of 1.20 %o. In the congener analyses in serum, a median 2-butanol concentration of 0.79 mg/1 (range 0.45-1.34 mg/1) and of 1.01 mg/I (0.44-1.62 mg/1) for 2-butanone were measured. The concentration-time curve was biphasic starting with a slow and plateau-like elimination. However, considerable inter-individual differences were observed. Only in 3 subjects, a 2-butanol : 2-butanone ratio below 1 suggested ingestion within the last 6 hours. The majority of the subjects exhibited higher concentrations of 2-butanone than of 2-butanol such that the ratio was always smaller than 1. According to the present results the concentrations of 2-butanol and 2-butanone or their ratio do not provide a reliable basis to draw conclusions on the time of grappa ingestion.
[Matching bite marks using modeling wax plates].
Wagner R, Madea B, Doberentz E
Arch Kriminol · 2017 Jan · PMID 29791111
Bite marks are rarely seen in forensic medical examinations. In most cases one can easily differentiate whether a bite mark is of human or animal origin due to the arched shape and crushed character of human bite marks....
Bite marks are rarely seen in forensic medical examinations. In most cases one can easily differentiate whether a bite mark is of human or animal origin due to the arched shape and crushed character of human bite marks. From a forensic point of view it is more interesting whether a dental imprint has been caused by an adult or a child, because children are often abused for a defensive statement. Two cases of bite injuries in children are presented. In the first case, a two-month-old infant was presented by pediatricians. The second case deals with a one-year-old boy who had allegedly been bitten several times by a two-year-old girl in a nursery school. A comparison could be performed between the bite mark impressions on the victim's skin (based on photographic documentation) and dental imprints of single teeth measuring the tooth width on the one hand and the intercanine distance on the other hand with the help of modeling wax plates. This procedure showed good correlations between the bite marks on the victim and the dental status of the biter. Especially for taking bite impressions on children, modeling wax plates are a simple, fast and cheap alternative to dental impression-taking.
[National and international aspects of the medico-legal examination of injured witnesses and defendants in criminal proceedings].
Dettmeyer RB, Christoph CG
Arch Kriminol · 2017 Jan · PMID 29791110
Depending on the type of offence, the medico-legal examination of victims of violence for the purpose of collecting evidence in criminal proceedings requires prompt physical examination of the victim, the exact descripti...
Depending on the type of offence, the medico-legal examination of victims of violence for the purpose of collecting evidence in criminal proceedings requires prompt physical examination of the victim, the exact description and, wherever possible, photographic documentation of the injuries and their forensically correct interpretation. Examination, documentation and assessment have to meet minimum standards. In addition it must be ensured that the examiner or expert has an independent organisational, administrative and financial status. An independent expert must not be an organisational part of the police force, the public prosecution and the court. Legal regulations have to make sure that the expert cannot be influenced "through official channels". His or her financial independence must make attempted bribery at least improbable. The independence of the expert is particularly important, if persons become victims of violence while they are under the custody of the state, especially the police, in prisons and after compulsory commitment to a psychiatric hospital.
Unusual planned complex suicide committed with a muzzle-loading pistol in combination with subsequent hanging.
Ondruschka B, Morgenthal S, Dreβler J … +1 more , Bayer R
Arch Kriminol · 2016 Nov · PMID 29465869
In Germany, suicides by firearms are not very common in contrast to deaths by hanging and intoxications. The use of historical muzzle-loading firearms in the context of suicides is a rarity. Contact shots from muzzle loa...
In Germany, suicides by firearms are not very common in contrast to deaths by hanging and intoxications. The use of historical muzzle-loading firearms in the context of suicides is a rarity. Contact shots from muzzle loaders cause an unusual wound morphology with extensive soot soiling. We report the case of a 59-year-old man, who committed a planned complex suicide by shooting into his mouth with a replica percussion gun in combination with hanging. The gunshot injury showed strong explosive effects in the oral cavity with fractures of the facial bones and the skull associated with cerebral evisceration (so-called Krönlein shot). Due to the special constellation of the case with hanging immediately after the shot, external bleeding from the head injuries was only moderate. Therefore, the head injuries could be assessed and partially reconstructed already at the scene.
[Quality of death certificates in hospitals].
Schröder AS, Sperhake J
Arch Kriminol · 2016 Nov · PMID 29465868
The cause-of-death-statistics and the release of the body for burial depend primarily on the information contained in the death certificate. How to handle the death certificate has been critically discussed in profession...
The cause-of-death-statistics and the release of the body for burial depend primarily on the information contained in the death certificate. How to handle the death certificate has been critically discussed in professional circles again and again. A retrospective review of 1,315 deaths from six acute care hospitals in Germany was carried out with regard to the quality of the death certificates, taking into account information contained in the medical records. The review covered the readability of the death certificate, the quality of the epicrisis, misclassifications relating to the manner of death and the degree of certainty regarding the cause of death. In 93 % of cases (n= 1,221), death certificates were clearly legible. In about half the cases (43.3 %, n=569), the quality of the entries in the "epicrisis" section was good. In 45 % of cases (n= 592), no details were provided in the "epicrisis " section. In 3.9 % (n = 42) of deaths classified as natural, information was given indicating a non-natural death. Most of these deaths occurred in connection with a fall or an injury (n = 27) or possible errors relating to treatment or care (n = 7). Overall, the review showed that clinicians handled the medical death certificate in a competent and careful manner. However, based on the content of the files, the review identified individual and avoidable misclassifications as to the manner of death and improbable causes of death; it also demonstrated that information on the epicrisis is often missing and needs significant improvement.
Lethal hypothermia after firing a suicidal shot to the head in a car.
Ortmann J, Doberentz E, Kernbach-Wighton G … +1 more , Madea B
Arch Kriminol · 2016 Nov · PMID 29465867
In suicide cases involving an automobile, the car is mostly used as a tool/instrument for the suicide (intoxication by exhaust fumes, crash against solid objects such as a pylon). However, a car is uncommonly also used o...
In suicide cases involving an automobile, the car is mostly used as a tool/instrument for the suicide (intoxication by exhaust fumes, crash against solid objects such as a pylon). However, a car is uncommonly also used only as the location for a suicide. In the present case, a 70-year-old man had been found dead on the passenger seat of his car. According to witnesses, the car had not been parked there at the same time of the previous day. During that period, the weather had been dry, with temperatures ranging from -1⁰ C at night to +5⁰ C during the day. The man had shot himself with a small-caliber revolver (so-called bulldog-revolver) almost horizontally in the left temple (transtemporal shot through the frontal lobes). Obviously, the suicide had retained the capability to act at least for a short time, as the revolver was found under his left bottom. As morphological signs of prolonged agony some findings of hypothermia were observed (e. g. Wischnewski spots of the stomach).
Field study to detect illicit and medicinal drugs in car drivers in Southern and Western Hesse.
Paulke A, Wunder C, Toennes SW
Arch Kriminol · 2016 Nov · PMID 29465866
In the present study, immunochemical tests (Mahsan DrugInspector, DOA4, DOA8, DOA10, Protzek) as well as the detection rate of police checks were evaluated. Urine and blood samples of suspected car drivers were analysed...
In the present study, immunochemical tests (Mahsan DrugInspector, DOA4, DOA8, DOA10, Protzek) as well as the detection rate of police checks were evaluated. Urine and blood samples of suspected car drivers were analysed by chromatography-mass spectrometry. Additionally, anonymised urine samples were analysed on a voluntary basis in cases where no legal proceedings were initiated. Toxicological analyses (total unknown screening) were performed using gas chromatography-mass spectrometry (GC-MS) after hydrolysis, acidic and alkaline extraction and derivatization. A data base for screening 9000 substance entries was applied. In addition, urine samples were analysed using liquid chromatography/ time-of-flight mass spectrometry (HPLC-ToF-MS) to screen psychiatric and narcotic drugs. In total, samples of 154 suspects were analysed, of these, 46 samples for no actual reason. In 5 of the latter samples, forensically relevant substances were detected; in two cases the consumption of illicit drugs, i. e. cannabis and methamphetamine, was proved. Of the 154 suspects, 108 were charged with driving under the influence of drugs; in samples of 103 of these cases, illicit drugs were found. Immunochemical pretesting showed posi- tive results in 97 of the 108 cases; in 6 samples, psychiatric drugs (citalopram, doxepin, promethazine, mirtazapine, fluoxetine, venlafaxine) were later identified, which are not detectable by ordinary pretesting systems. Police officers successfully identified 95.4 % of the suspects as drug consumers, which is an excellent result. In practice, pretesting of urine samples using immunochemical techniques proved to be very reliable. The Protzek system in particular corresponded well with the results of the chromatographic analyses. In conclusion, systematic chromatographic-mass spectrometric analysis of urine samples of suspects is recommended to identify car drivers consuming illicit drugs and to obtain data usable in legal proceedings (e. g. suspending of the driving license), which is not always possible when using blood samples in cases of drugs consumed some time ago.
Nicolò Paganini's hair lock for Signora Chatterton - morphological hair investigations using digital light microscopy.
Otte A, Kijewski H
Arch Kriminol · 2016 Nov · PMID 29465865
The famous violin virtuoso Nicolò Paganini (born on 27 October 1782 in Genoa, died on 27 May 1840 in Nice) left us with many puzzles. An interesting aspect is his hair: In the 19th century, hair given away as a token of...
The famous violin virtuoso Nicolò Paganini (born on 27 October 1782 in Genoa, died on 27 May 1840 in Nice) left us with many puzzles. An interesting aspect is his hair: In the 19th century, hair given away as a token of friendship or romantic love became very popular, and Paganini also seems to have made use of this fad. In 2009, a lock of hair, purportedly that of Paganini, kept in a locked presentation box together with a bilingual autograph inscription saying: "Alla Signora Chatterton avec les compliments de Nicolò Paganini" was bought at an auction. From this hair lock a sample was taken and was investigated morphologically by using digital light microscopy (digital microscope VHX-100, Keyence) in reflected and transmitted light with and without polarization at different magnifications up to 1:5,000. The sample was then compared with a hair sample from the possession of the Paganini family, which had been microscopically examined in 2012 by the co-author of this paper yielding numerous figures with measurement results that had been stored and could be retrieved for direct comparison. The hair sample consisted of ten strands of hair or hair fragments and was investigated with great effort for the following parameters: exogenous hair damage, especially feeding traces caused by parasites, modeling and angulation of hairs, hair thickness, medulla and pigmentation, curling and mercury load on the trace material. After evaluation of all findings not only a non-exclusion of identity can be determined, but due to the broad match of also rare findings there is no reasonable doubt about their identity. In addition, the findings suggest that the studied hair samples are in fact from Paganini's head. The present case of Nicolò Paganini's hair lock is also an excellent starting point for reflections on the probative value of trace hair investigations. This point is also critically discussed in the paper. Finally, this study shows that said lock of hair had probably really been dedicated and given to Eliza Davenport Latham (born on 25 November 1806, died on 9 January 1877), the future wife of the, at that time, best-known and most famous English harpist John Balsir Chatterton (born on 25 November 1804, died on 9 April 1871). Paganini must have met her on his concert tour 1831/32, where he had travelled to Paris, London, the rest of England, Scotland and Ireland.
Histological and immunohistochemical investigations on infantile pancreas in cases of sudden infant death syndrome (SIDS).
Doberentz E, Feiser J, Madea B
Arch Kriminol · 2016 Sep · PMID 29870177
The sudden infant death syndrome (SIDS) is defined as unexpected death of a previously healthy infant with no cause of death being established. Comprehensive histological and immunohistochemical investigations are requir...
The sudden infant death syndrome (SIDS) is defined as unexpected death of a previously healthy infant with no cause of death being established. Comprehensive histological and immunohistochemical investigations are required subsequent to autopsy. In 18 cases of sudden infant death, histological (H&E, PAS and iron stain) and immunohistochemical investigations (CD68, CD45RO and LCA) were performed regarding a possible role of pancreatitis in SIDS and histomorphological alterations of the pancreatic islets, respectively. In all the investigated cases, no inflammatory changes of the infantile pancreatic tissue and no other significant histomorphological alterations of the pancreatic islets were found.
Malrotation syndrome resulting in fatal ileus in children.
Kernbach-Wighton G, Amberg R, Zimmer' Gisela … +1 more , Madeal B
Arch Kriminol · 2016 Sep · PMID 29870176
BACKGROUND: This report deals with two deaths of children involving intestinal volvulus, i. e. a pathological knotting and twisting of the mesenterial root on the basis of congenital malrotation followed by obstruction a...
BACKGROUND: This report deals with two deaths of children involving intestinal volvulus, i. e. a pathological knotting and twisting of the mesenterial root on the basis of congenital malrotation followed by obstruction and extensive ischaenia. CASE REPORTS: (1) A 10-year-old girl (premature, 25th week) with severe disability, amaurosis and epilepsy was admitted to hospital due to general agitation and a bloated abdomen without peristaltic sounds, but died some hours later. Autopsy revealed a volvulus of 2/3 of the small intestine based on congenital malrotation with additional clamping of the intestine underneath adhesions (previous appendectomy). The abdominal cavity showed beginning peritonitis as the cause of death. (2) A 2-month-old premature male baby (surviving twin, 29th week) with a persisting ductus arteriosus was hospitalised for four weeks after failed vascular surgery due to acute general deterioration. Radiological diagnostics using a contrast medium revealed a vascular anomaly (right-sided aortic arch). Around 10 hours later, the infant developed an acute abdomen with ileus symptoms. Emergency surgery showed infarction of the entire small intestine due to an anti-clockwise 180⁰-volvulus, with death occurring 24h later. Further examination showed a malrotation as anomaly. Apparently, the volvulus had been caused by extensive use of contrast medium resulting in increased intestinal mobility.
Fatal visit to the general practitioner.
Sterzik V, Wild V, Weishaupt Julia … +3 more , Tatschner T, Babel B, Bohnert M
Arch Kriminol · 2016 Sep · PMID 29870175
A 31-year-old female asthmatic patient received an infusion of metamizole and tramadol for chronic pain at a GP surgery. After a few minutes, the patient developed breaing difficulties and died in spite of resuscitation...
A 31-year-old female asthmatic patient received an infusion of metamizole and tramadol for chronic pain at a GP surgery. After a few minutes, the patient developed breaing difficulties and died in spite of resuscitation measures. The general practitioner was suspected of medical malpractice. Medico-legal investigations confirmed the assumption that death was caused by anaphylacitic shock. In spite of temporary intubation into the oesophagus no evidence of medical malpractice was found, however.
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