Numerous theories on the pathomechanism of SIDS favor a multifactorial genesis whereby infections of the upper respiratory tract and the pulmonary tissue have a trigger function. The aim of the presented study was to pro...Numerous theories on the pathomechanism of SIDS favor a multifactorial genesis whereby infections of the upper respiratory tract and the pulmonary tissue have a trigger function. The aim of the presented study was to prove the presence of inflammatory responses in pulmonary tissue in SIDS cases because various studies revealed contradictory results about the evidence of inflammatory pulmonary responses in SIDS cases. For this purpose, 10 cases with defined causes of death were examined in comparison to 75 cases of sudden infant death syndrome (SIDS) with regard to CD45RO, CD68 and LCA positive cells in pulmonary tissue. Furthermore, the cell adhesion molecules E-selectin, P-selectin and VCAM were investigated. In the study group, the immunohistochemical imaging of CD45RO and LCA positive cells showed mostly negative results. There were no significant differences between study and control group as to the number of cells expressing CD45R0, CD68 and LCA. The same was true for the adhesion molecules E-selectin, P-selectin and VCAM.
Hein H, Püschel K, Schaper A
… +1 more, Iwersen-Bergmann S
Arch Kriminol
· 2016 · PMID 26934765
Despite the medial attention attracted by the presented case in January 2012 and the determined measures taken to minimize the risk of accidental poisoning for children in the direct surroundings of substituted persons,...Despite the medial attention attracted by the presented case in January 2012 and the determined measures taken to minimize the risk of accidental poisoning for children in the direct surroundings of substituted persons, we recently faced two more cases of methadone-intoxicated children in Hamburg. We believe that the most important step to increase awareness of the dangerous effects of methadone for children might be the storage of methadone in lockable boxes, which would make it safe from access by children and third parties. Moreover this way of storing reminds the patients of the risks resulting from their medication. Repeated and comprehensive instruction appears to be the best protection against cases like this to counteract careless handling of the substitution medication.
Schmidt S, Schramm D, Ribbecke S
… +9 more, Schulz R, Wittschieber D, Olze A, Vieth V, Ramsthaler HF, Pfischel K, Pfeiffer H, Geserick G, Schmeling A
Arch Kriminol
· 2016 · PMID 26934764
The dramatic rise in the number of refugees entering Germany means that age estimation for juveniles and young adults whose age is unclear but relevant to legal and official procedures has become more important than ever...The dramatic rise in the number of refugees entering Germany means that age estimation for juveniles and young adults whose age is unclear but relevant to legal and official procedures has become more important than ever. Until now, whether and to what extent the combination of methods recommended by the Study Group on Forensic Age Diagnostics has resulted in a reduction of the range of scatter of the summarized age diagnosis has been unclear. Hand skeletal age, third molar mineralization stage and ossification stage of the medial clavicular epiphyses were determined for 307 individuals aged between 10 and 29 at time of death on whom autopsies were performed at the Institutes of Legal Medicine in Berlin, Frankfurt am Main and Hamburg between 2001 and 2011. To measure the range of scatter, linear regression analysis was used to calculate the standard error of estimate for each of the above methods individually and in combination. It was found that combining the above methods led to a reduction in the range of scatter. Due to various limitations of the study, the statistical parameters determined cannot, however, be used for age estimation practice.
The number of tattooed people in Germany has constantly grown over the past few years. The present study deals with the question if this social trend can be seen in foren- sic autopsy cases as well. In a retrospective st...The number of tattooed people in Germany has constantly grown over the past few years. The present study deals with the question if this social trend can be seen in foren- sic autopsy cases as well. In a retrospective study, forensic autopsy cases of two periods (1990-1994 and 2010-2014) have been reviewed and statistically analyzed. Comparison of the two periods revealed a significant increase in tattooed individuals, especially in the female subgroup. Between 2010 and 2014, 14.2 % of the deceased showed tattoos. There are significant differences in the frequency and localization of tattoos dependent on age and sex. About 50 % of the tattooed deceased showed tattoos on body sites that are visible for other persons in everyday life. The resulting value of tattoos for the purpose of identifying unknown bodies is discussed and illustrated.
Estimation of the time of immersion is a common problem in forensic medicine. In Germany since about 50 years a table for estimating the minimum time interval of immersion is used. This table was developed taking into ac...Estimation of the time of immersion is a common problem in forensic medicine. In Germany since about 50 years a table for estimating the minimum time interval of immersion is used. This table was developed taking into account signs of progressive putrefaction and maceration and the monthly average water temperature. The reliability of this table was already checked some years ago. In the study presented, 33 further cases were evaluated. When the average monthly water temperatures used in the table are compared to the actual values, the temperatures in the river Rhine have risen during the last 40 years. Therefore, always the actual water temperature has to be measured and to be taken into consideration for the estimation of immersion time. Since there may be also fluctuations of the monthly water temperatures in cases of longer lasting immersion, a temperature profile has to be taken and the mean water temperature has to be calculated. Besides, the table of Reh should be adapted to the increased water temperatures.
Birngruber CG, Eschmann R, Kettner M
… +2 more, Ramsthaler F, Verhoff MA
Arch Kriminol
· 2016 Mary · PMID 29869868
The term "kidney shrinkage", which is used in both pathological anatomy and clinical contexts, is not uniformly defined. In medicolegal practice, it is particularly important whether or not a cause of death can be inferr...The term "kidney shrinkage", which is used in both pathological anatomy and clinical contexts, is not uniformly defined. In medicolegal practice, it is particularly important whether or not a cause of death can be inferred from this diagnosis. If this were the case, a shrunken kidney determined in a forensic autopsy would obtain the same significance as a competing cause of death. International medical journals and German-language textbooks were searched for definitions of the various terms used to denote this condition, and the definitions were reassessed. The term "kidney shrinkage" was found to have historical roots and has further evolved since the 19th century. Although the first use of the term could not be determined with certainty, Bright (1789-1858) appears to be one of the first to use it in describing kidney disease. Definitions given in modern textbooks are based on kidney function, size, or macromorphology. However, these definitions lack uniformity and are often unsubstantiated. Because of its evocative power, the use of the historically coined term "kidney shrinkage" appears justified, at least as part of the medicolegal practitioner's jargon, to describe kidneys that have an uneven surface, decreased renal parenchyma, and a weight of less than 80 g, even if the term does not allow deductions about the degree of renal insufficiency and, thus, the significance of kidney shrinkage as the cause of death. The evaluation of such aspects requires histological analysis or referral to the results of clinical chemistry analyses that may have been performed while the individual was still alive.
Stockhausen S, Mohle F, Wollner K
… +2 more, Madea B, Kernbach-Wighton G
Arch Kriminol
· 2016 Mary · PMID 29869867
Over one year, 7 autopsy cases with narrow diameters of the descending aorta were seen in the Institute of Forensic Medicine at the University of Bonn. The autopsy results were supplemented by chemical-toxicological, alc...Over one year, 7 autopsy cases with narrow diameters of the descending aorta were seen in the Institute of Forensic Medicine at the University of Bonn. The autopsy results were supplemented by chemical-toxicological, alcohol and histological examinations. In all cases middle-aged men (24-38 years) died suddenly and predominantly in a domestic environment. To some extent the inner aortic diameters ranged significantly below the expected values in relation to body surfaces or were lower than the 5th percentile related to men aged 45 years. In four cases, potentially lethal concentrations of alcohol or intoxications, e.g. with heroin, were noted. In one case, the blood sugar level was significantly elevated. In the other two cases, all further investigations were unremarkable.
As part of the collection in the Hans Gross Museum of Criminology in Graz there are still three crime scene reliefs; two of which were made by Hans Gross himself. The practical purpose of these criminal landscape models...As part of the collection in the Hans Gross Museum of Criminology in Graz there are still three crime scene reliefs; two of which were made by Hans Gross himself. The practical purpose of these criminal landscape models is something one could speculate about, but such models may have been useful in two fields: in the criminal lab and in the courtroom. To see the reliefs in a scientific experimental context as well as under the aspects of artwork and topography is as essential as emphasizing their genuine military character.
Klinger CSE, Derra KA, Reiter G
… +3 more, Wunder C, Toennes SW, Paulke A
Arch Kriminol
· 2016 Mar · PMID 29869865
Congener alcohol (CA) analysis became an important tool in forensic science to prove the kind of alcoholic beverage consumed. The aim of the present study was to determine the influence of yeast strain and apple variety...Congener alcohol (CA) analysis became an important tool in forensic science to prove the kind of alcoholic beverage consumed. The aim of the present study was to determine the influence of yeast strain and apple variety on the formation of congener alcohols in self-produced apple wine. There exist data on CA patterns of industrially produced alcoholic beverages, but these are not available for apple wine. Must from five different commercial as well as from six genuine apple varieties were used for fermentation under similar conditions CA formation was monitored during the fermentation process. Additionally, nine commercial apple wines from commercial producers were analyzed. Analysis was performed by headspaces-GC-MS. All apple wines contained markedly high contents of the CA 3-methylbutan-1-ol (88-251 mg/L). Compared to self-produced apple wines from genuine musts the industrial apple wines (purchased in supermarkets and self-produced from commercial musts) exhibited significant differences in methanol concentrations(8.5-94 mg/L), whereas all other CAs, such as propan-1-ol, butan-1-0l, 2-methylpropan-1-ol(isobutanol), 3-methyl-butan-1-oi, and 2-methylbutan-1-oi, were found to be present in similar concentrations. Methanol was not detectable in apple wine made from genuine musts during fermentation but after a storage period. In some cases, concentrations of some CAs additionally changed during storage. This may be explained by a secondary (unwanted) fermentation after bottling. According to the data obtained in the present study, it is recommended to analyze a sample of the allegedly consumed apple wine in forensic cases, rather than to rely on data obtained from the literature or from some data collections.
Manual laterality (handedness) in humans has some significance for forensic practice where it is primarily employed in the form of handedness preference, based on a simplified three-stage classification (right-handed, le...Manual laterality (handedness) in humans has some significance for forensic practice where it is primarily employed in the form of handedness preference, based on a simplified three-stage classification (right-handed, left-handed and ambidextrous). In cases of homicide or suicide, the pattern of injuries, particularly cutting or stab injuries and gunshot wounds, may provide clues as to the perpetrator's handedness. In injuries inflicted by another person, the pattern of findings can in isolated cases allow to draw conclusions as to the handedness of the perpetrator. In self-inflicted injuries and suicide, the dominant hand is usually used either alone or as the lead hand. If it is found that fatal injuries were inflicted by the non-dominant hand, this gives rise to doubt that the manner of death is suicide. Evidence of handedness is of little value in distinguishing between suicide and homicide. Due to new developments in dentistry, imaging procedures and especially genetics, the utility of handedness in the identification of unknown persons or cadavers has significantly diminished. In living subjects, useful evidence of handedness can be obtained by observing the performance of specific gestures or activities. The subject should be asked to perform tasks involving one and two hands in a specific sequence. Standardised measurements of the morphology of the shoulders and upper extremities are able to make a statistical distinction between right and left. Since the accuracy of this process is, however, only,around 75 %, morphological determination of handedness should not be used in living subjects, but should be restricted to the identification of unknown cadavers or other post-mortem examinations.
Wöllner K, Ortmann J, Kernbach-Wighton G
… +1 more, Madea B
Arch Kriminol
· 2015 · PMID 26548037
Restraining patients is common practice in psychiatric hospitals and is permitted by section 1906 BGB (German Civil Code) if there is a risk of suicide or serious self-damage because of a mental disease or mental disabil...Restraining patients is common practice in psychiatric hospitals and is permitted by section 1906 BGB (German Civil Code) if there is a risk of suicide or serious self-damage because of a mental disease or mental disability. Permanent monitoring and supervision during restraints should be obligatory not only in psychiatric hospitals. Nevertheless a number of deaths have occurred during restraints, usually due to strangulation. Reports of cases with suicidal actions after self-release from restraint are rare in the literature. We report on the case of a 45-year-old woman who had suffered from schizophrenia for more than 20 years. After admission to a hospital, she had to be restrained since she became more and more aggressive. When the monitor showed no vital signs any more, nurses checked the patient's room and found an empty bed. The woman was detected lying on the ground in a pool of blood under an open window of the hospital. The cause of death was a polytrauma with leading cranio-cerebral injuries. Obviously the woman had freed herself from the restraining device and committed suicide by jumping out of the window on the third floor.
Geisenberger D, Kramer L, Pircher R
… +1 more, Pollak S
Arch Kriminol
· 2015 · PMID 26548036
On 30 Jan 2015, two avalanche accidents happened in the Black Forest (at the foot of the 1493 m high Feldberg and the Herzogenhorn situated next to it), in which experienced ski tourers--a 58-year-old woman and a 20-year...On 30 Jan 2015, two avalanche accidents happened in the Black Forest (at the foot of the 1493 m high Feldberg and the Herzogenhorn situated next to it), in which experienced ski tourers--a 58-year-old woman and a 20-year-old man--were completely buried by snow masses. Both victims were recovered dead after nearly 2 hours under the snow. The avalanches were promoted by strong snowfalls, snowdrift by the wind and steep downwind slopes. One of the victims, the 20-year-old man, underwent a forensic autopsy. The findings suggested death by protracted asphyxiation with agonal hypothermia. A mechanical traumatization with internal injuries suspected by the emergency doctor at the scene could not be confirmed at autopsy. The possible causes of death in the avalanche are discussed using the reported case as an example and in reference to the relevant literature.
Alcoholic ketoacidosis is a medical emergency, which is characterized at first by an elevated level of ketone bodies. The production of these ketone bodies is accompanied by an equimolar quantity of hydrogen ions and thu...Alcoholic ketoacidosis is a medical emergency, which is characterized at first by an elevated level of ketone bodies. The production of these ketone bodies is accompanied by an equimolar quantity of hydrogen ions and thus causes acidosis, which cannot be detected post-mortem due to anaerobic glycolysis, whereas the three ketone bodies beta-hydroxybutyrate, acetoacetate and acetone can be easily identified. However, the limits of ketone body concentrations mentioned in the literature for diagnosing ketoacidosis vary significantly, partly due to inhomogeneous study groups. A 44-year-old woman was found dead with numerous haematomas and partial mummification. Some days before, she had reported her partner to the police for rape. Consequently investigations for homicide were initiated. The autopsy itself did not reveal any morphologically identifiable cause of death. The ketone body concentrations in three matrices (vitreous humour, cerebrospinal fluid, cardiac blood) left no doubt that death was due to alcoholic ketoacidosis.
Zirwes C, Ritz-Timme S, Hinsch N
… +2 more, Kardel B, Hartung B
Arch Kriminol
· 2015 · PMID 26548034
A man who suffered from chronic pain syndrome died two days after intravenous injection of 2 ml benzine. Previous suicide attempts by drug intoxication and strangulation had failed. Death occurred due to multi-organ fail...A man who suffered from chronic pain syndrome died two days after intravenous injection of 2 ml benzine. Previous suicide attempts by drug intoxication and strangulation had failed. Death occurred due to multi-organ failure. We present the results of the clinical, morphological and toxicological examinations performed.
Ondruschka B, Schneider E, Hädrich C
… +2 more, Dreßler J, Bayer R
Arch Kriminol
· 2015 · PMID 26548033
A 40-year-old woman died shortly after complaining of non-specific symptoms after a pharmacist had accidentally given her the wrong medication. The woman's partner was not familiar with her medical history and the medica...A 40-year-old woman died shortly after complaining of non-specific symptoms after a pharmacist had accidentally given her the wrong medication. The woman's partner was not familiar with her medical history and the medical file had to be obtained from the family doctor. Autopsy findings and histological examination confirmed the clinically diagnosed autoimmune polyglandular syndrome without a tangible cause of death. Poisoning could not be demonstrated and no relation between the dosage error and death could be established. Laboratory tests revealed diabetic coma with ketoacidosis as the cause of death, which was probably caused by a prolonged lack of insulin administration. In addition to the clarification of legal issues, the complete post-mortem examination of orphan diseases is also relevant for achieving a better understanding of differential diagnostic aspects and complex pathophysiological contexts. Moreover, the genetic background often underlying such diseases should be a reason to inform the family of the deceased about the autopsy results. Only then can secondary preventive measures be taken in time.
On 26 Nov 2012, a serious fire occurred at Neustadt/Black Forest in which 14 persons in a sheltered workshop died and 10 other individuals were injured. The fire was caused by the unbridled escape of propane gas due to a...On 26 Nov 2012, a serious fire occurred at Neustadt/Black Forest in which 14 persons in a sheltered workshop died and 10 other individuals were injured. The fire was caused by the unbridled escape of propane gas due to accidental disconnection of the screw fixing between a gas bottle and a catalytic heater. Deflagration of the propane gas-air mixture set the workshop facilities on fire. In spite of partly extensive burns the fatally injured victims could be rapidly identified. The results of the fire investigations at the scene and the autopsy findings are presented. Carboxyhemoglobin concentrations ranged between 8 and 56 % and signs of fire fume inhalation were present in all cases. Three victims had eardrum ruptures due to the sudden increase in air pressure during the deflagration.
This article presents an online survey on medico-historical (neuro-)prostheses. Important findings of the past 3000 years are outlined: toe prostheses from ancient Egypt, the Capua leg prosthesis, Götz von Berlichingen's...This article presents an online survey on medico-historical (neuro-)prostheses. Important findings of the past 3000 years are outlined: toe prostheses from ancient Egypt, the Capua leg prosthesis, Götz von Berlichingen's artificial hands and Sauerbruch's prosthetic arm. These historical examples are compared with modern neuroprosthetics. It is also shown that historical prostheses were in no way primitive and, even more, that ancient people already used first intelligent medical engineering approaches.
The medico-legal assessment of potentially self-inflicted injuries is an important field of clinical forensic medicine. Compared with sharp force injuries, it is much more difficult to distinguish blunt injuries caused b...The medico-legal assessment of potentially self-inflicted injuries is an important field of clinical forensic medicine. Compared with sharp force injuries, it is much more difficult to distinguish blunt injuries caused by another party from self-inflicted lesions. We present a case of a young female doctor, who was allegedly attacked by an unknown stranger during her evening walk in the woods. She claimed to have been hit repeatedly on the head and arms with a stone. During the forensic investigation, blunt injuries could be confirmed on her head and forearms. Based on the arrangement and intensity of the injuries, together with the result of a bloodstain pattern analysis of the weapon, the victim's statement could be disproved. After being confronted with the results of the investigation, the woman admitted to have inflicted the injuries herself. This case is an unusual and rare example of self-inflicted blunt injury. It shows that the criteria of self-inflicted injuries can also be applied to blunt trauma. However, due to the small number of cases, a high degree of caution is required from the forensic expert.
Bäuerle L, Kanitz U, Laurich S
… +5 more, Naumovska K, Fröb D, Krebs O, Wilkens A, Püschell K
Arch Kriminol
· 2014 · PMID 26548020
Myiasis is known as the infestation of living organisms with maggots. It is often caused by (self-) neglect. Eight cases of myiasis have been examined at the Institute of Legal Medicine in Hamburg between 2002 and 2014....Myiasis is known as the infestation of living organisms with maggots. It is often caused by (self-) neglect. Eight cases of myiasis have been examined at the Institute of Legal Medicine in Hamburg between 2002 and 2014. It is important that the medical examiner compares the maggots' stage of development with the alleged time of death. Especially in cases of home care, myiasis and neglect are suspicious and deserve special attention.