Esophageal rupture through extreme sadomasochistic practice.

We report the case of a woman in her thirties who suffered an esophageal rupture while participating in extreme sadomasochistic practices. After herself seeking help in a hospital for complaints alleged to be from a fall, she was initially diagnosed with several broken ribs and a pneumothorax. The cause of the pneumothorax was later discovered to be an esophageal rupture. When confronted with this atypical injury for a fall, the woman admitted to have accidentally swallowed an inflatable gag, which her partner had afterwards inflated. In addition to the esophageal rupture, the patient also had numerous other externally visible injuries of various ages, reportedly also from sadomasochistic acts. Although an in-depth police investigation was conducted and a "slave contract" was found, the woman's consent to the extreme sexual practices performed by her life partner could not be substantiated conclusively. The man was convicted for intentional infliction of serious as well as dangerous bodily injury and sentenced to a long term in prison.

A guide to classify tattoo motives in Mexico as a tool to identify unknown bodies.

JUSTIFICATION: In Mexico, the number of unidentified bodies has been steadily rising for years. By now, more than 50,000 bodies are considered unidentified. Forensic laboratories that could perform comparative molecular genetic investigation are often overburdened and examinations can take months. Therefore, pragmatic approaches that can help to identify more unknown bodies must be sought. The increased use of distinctive physical features might be one, and the high rate of tattooed people in Mexico points towards a great potential of tattoos as a tool for identification. The prerequisite for a comparison of antemortem (missing persons) and postmortem (unknown bodies) data is an objective description of the particularities, e.g., of the tattoos. The aim of this study was to establish an objective classification for tattoo motives, taking into consideration local preferences. METHODS: In the database of the medicolegal services of the Instituto Jaliscience de Ciencias Forenses (IJCF) in Guadalajara, postmortem data of 1000 tattooed bodies from 2019 were evaluated. According to sex and age, the tattooed body localization and the tattoo motives were categorized. RESULTS: The 1000 tattooed deceased showed tattoos on 2342 body localizations. The motives were grouped and linked to the following 11 keywords (with decreasing frequency): letters/numbers, human, symbol (other), plant, symbol (religious), animal, object, fantasy/demon/comic, tribal/ornament/geometry, other, unrecognizable. CONCLUSION: Using the proposed classification, tattoo motives can be described objectively and classified in a practical way. If used for antemortem (missing persons) and postmortem (unknown bodies) documentation, motives can be searched and compared efficiently-helping to identify unknown bodies.

Assessment of renal glomerulosclerosis and thickness of the carotid intima-media complex as a means of age estimation in Western European bodies.

INTRODUCTION: The estimation of age-at-death of unidentified cadavers is a central aspect of the identification process. With increasing age, the incidence of glomerulosclerosis and the thickness of the carotid wall have been observed to also increase. This correlation has been demonstrated in various international histological studies. The aim of our study was to assess whether these correlations also apply to a Western European population. METHODOLOGY: In this retrospective observational study, kidney and common carotid artery samples from 216 cases autopsied at the Institute of Legal Medicine at the Justus-Liebig University in Giessen, Germany, were examined. Only cases with available tissue samples from both body sides were included. Exclusion criteria were poor sample quality and an age younger than 21 years. After histological processing, the tissue samples were assessed and digitally evaluated. Regression and classification analyses were used to investigate the correlation between age-at-death and intima-media thickness and age-at-death and the incidence of renal glomerular sclerosis. RESULTS: Of the 216 autopsy cases, 183 were included for evaluation. Analysis of the carotid artery segments showed a strong correlation (Pearson correlation coefficient r = 0.887) between the intima-media-complex thickness and chronological age. Classification of the glomerulosclerotic incidence showed a correlation of 37.7-43.1% with the predicted age group. DISCUSSION: Both the intima-media thickness and the proportion of sclerotic glomeruli can be used to estimate age in Western European cadavers. On the basis of these results, both methods are suited to supplement other already established methods for age-at-death estimation in the identification of an unknown cadaver.

Mongolian spots as a finding in forensic examinations of possible child abuse-implications for case work.

Mongolian spots (MS) are congenital dermal conditions resulting from neural crest-derived melanocytes migration to the skin during embryogenesis. MS incidences are highly variable in different populations. Morphologically, MS present as hyperpigmented maculae of varying size and form, ranging from round spots of 1 cm in diameter to extensive discolorations covering predominantly the lower back and buttocks. Due to their coloring, which is also dependent on the skin type, MS may mimic hematoma thus posing a challenge on the physician conducting examinations of children in cases of suspected child abuse. In the present study, MS incidences and distribution, as well as skin types, were documented in a collective of 253 children examined on the basis of suspected child abuse. From these data, a classification scheme was derived to document MS and to help identify cases with a need for recurrent examination for unambiguous interpretation of initial findings alongside the main decisive factors for re-examination such as general circumstances of the initial examination (e. g., experience of the examiner, lighting conditions) and given dermatological conditions of the patient (e. g., diaper rash).

Unilateral and bilateral agenesis of the upper thyroid horns - A morphometric analysis of the larynx.

The agenesis of one or both upper thyroid horns (UTH) cannot be considered rare with an incidence ranging between 0.8-9.4%. Studies so far have mostly described frequencies, yet surveys on its morphology and traumatology are missing. It is unknown to what extent this anatomical variant impacts the overall symmetry of the larynx. For the trauma reconstruction after cervical trauma this knowledge is required as an asymmetric larynx can show a different fracture pattern. In this investigation, larynxes with unilateral (n=21)/bilateral (n=5) agenesis of the upper thyroid horn(s) and a control group with regular larynxes (n=23) were juxtaposed. Various measurements were taken after µ-CT scanning. In total 10 distances/angles for the thyroid cartilage and 8 for the cricoid cartilage were compared. Using intra-individual and matched pair comparisons the symmetry was assessed. The results of this investigation showed significant differences in the intra-individual and pairwise comparison for the opening angle and the length of the thyroid alae although the lateral inclination of the thyroid alae showed no significant difference. Combining these three parameters into one symmetry score, the comparison was not significant. This research demonstrates that neither unilateral nor bilateral agenesis of the UTH is related to a structural disbalance of the larynx. Thus, different fracture patterns or vulnerabilities are not to be expected.

Inhaled cyanide poisoning as a vital sign in a room fire victim.

The corpse of a 71-year-old woman was found on the floor of her smoke-filled room. The source of the fire was the mattress of a double bed on which newspapers had apparently been set aflame. The woman's history in conjunction with the finding situation suggested an act of suicide. No signs of soot inhalation or soot swallowing were found at autopsy. Other vital signs were absent. Severe cardiac disease was the most notable pre-existing medical condition. Although the concentration of COHb in heart blood was low (3%), the concentration of cyanide was found to be 4.3mg/l in heart blood and 1.9mg/l in lung tissue. Cyanide was not found in the stomach contents. The BAC (blood alcohol concentration) was zero. Several prescribed drugs could also be demonstrated. The cause of death was deemed to be cyanide poisoning, possibly in conjunction with the pre-existing cardiac disease. The reported case illustrates that a lethal amount of cyanide can be inhaled during a fire even if there is no inhalation or swallowing of soot and no significant increase in the COHb level. In such cases, the demonstration of cyanide assumes significance as a vital sign indicating that the victim was alive when the fire started.

Effect of anticoagulation therapy on drying times in bloodstain pattern analysis.

In forensic case work, blood stain pattern analysis frequently aids in deducing the chain of actions or parts thereof taking place during an event leading to blood loss. Wiped single blood stains and/or groups of blood stains are seen at a majority of complex crime scenes. The appearance of wiped blood stains depends on droplet volume and stain age (as a function of blood viscosity and the degree of stain skeletonization) and characteristics of the stained surface (i.e., texture, temperature). Furthermore, based on the biochemical and biophysical properties of blood, not only the drying processes, but also complex coagulation cascades are relevant to the assessment of wiped blood stains. This study was designed to determine if anticoagulation therapies markedly affect the wipeability of blood stains over times elapsed since deposition and the overall drying process. A total of 813 blood stains, originating from donors being treated with acetylsalicylic acid (ASA), clopidogrel + ASA, low-molecular-weight heparin, or rivaroxaban, were dropped on common household tiles. Wipeability at an ambient temperature of 20 °C was tested for 22 time periods (1, 2, 3, 5, 10, 15…105 min since deposition). Whereas stains consisting of untreated blood were dried within 55 min, wipeability of all droplets originating from donors with prior anticoagulation treatment showed pronounced delays compared with the control, ranging from 20 min (ASA and clopidogrel + ASA) to 45 min (rivaroxaban). This pronounced effect was not seen in earlier studies, which might be explained by the higher volume of droplets used in this study, which resulted in a shift in relevance from drying to clotting processes. Significant differences between the drying times of the various anticoagulation regimes might be attributed to anticoagulant activity against different targets in the coagulation cascades. In conclusion, anticoagulation treatment prior to blood loss significantly affected the wipeability of blood stains. Anticoagulation therapy should therefore be taken into account in the analysis of blood stain patterns.

Senior driving under the influence: A five-year retrospective study of alcoholized road-users aged 70 and over.

The demographic development in Germany shows a steady increase to senior citizens. The driving suitability of older road-users is of large social and political concern, because awareness and reactivity can be influenced by age-related diseases and potential medication, particularly in combination with the consumption of alcohol. This study provides an overview of senior road-users under the influence of alcohol. Therefore, 404 cases of drunken-driving by road-users aged 70 and over within the purview of the Institute of Legal Medicine at Justus-Liebig-University, Giessen, from the years 2009-2013 were evaluated in retrospect. The vast majority of the drivers were male (88.4% of the cases). Distribution of the blood alcohol concentrations were almost equally in male and female drivers with 62.8% of all cases showing a blood alcohol concentration (BAC) of more than 1.1‰ and 10.9% a BAC of more than 2.0‰. In 48.5% of the cases, drunk driving was associated with an accident. 54.5% of the drivers stated suffering from at least one disease and 60% admitted a regular medication or an intake prior to the incident. Moreover, the collected data includes aspects such as the kind of traffic participation as well as neurological and physiological deficits of the road-users. If accidents were caused by drunk driving, the external circumstances and consequences of these accidents were analyzed, too. The evaluation revealed, that the standard medical examination protocol proved to be improbable to cover polypharmacy and multimorbidity of older alcoholized drivers. So, an evaluation and adaptation of the common medical examination protocol must be considered.

[Stature estimation from teeth and jaw].

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.

[True color accuracy in digital forensic photography]. / Über die Farbdetailtreue in der digitalen forensischen Fotografie.

Forensic photographs not only need to be unaltered and authentic and capture context-relevant images, along with certain minimum requirements for image sharpness and information density, but color accuracy also plays an important role, for instance, in the assessment of injuries or taphonomic stages, or in the identification and evaluation of traces from photos. The perception of color not only varies subjectively from person to person, but as a discrete property of an image, color in digital photos is also to a considerable extent influenced by technical factors such as lighting, acquisition settings, camera, and output medium (print, monitor). For these reasons, consistent color accuracy has so far been limited in digital photography. Because images usually contain a wealth of color information, especially for complex or composite colors or shades of color, and the wavelength-dependent sensitivity to factors such as light and shadow may vary between cameras, the usefulness of issuing general recommendations for camera capture settings is limited. Our results indicate that true image colors can best and most realistically be captured with the SpyderCheckr technical calibration tool for digital cameras tested in this study. Apart from aspects such as the simplicity and quickness of the calibration procedure, a further advantage of the tool is that the results are independent of the camera used and can also be used for the color management of output devices such as monitors and printers. The SpyderCheckr color-code patches allow true colors to be captured more realistically than with a manual white balance tool or an automatic flash. We therefore recommend that the use of a color management tool should be considered for the acquisition of all images that demand high true color accuracy (in particular in the setting of injury documentation).

[Stature estimation from sagittal and coronal suture lengths for Central European individuals]. / Über die Korrelation von Schädelnahtlängen und Körperhöhe bei Mitteleuropäern.

$Human skulls frequently represent the only skeletal remains of an unidentified corpse available for forensic osteological examination. Skulls are very useful in reliably determining sex and also yield fairly good clues to an individual's age and ancestry. To date, however, a sufficiently accurate correlation between skull measurements and stature could not be found. In contrast, the results of a study by Rao et al. (2009) seemed to be promising, by finding a good correlation between the length of the coronal and sagittal sutures and stature in a male Indian population. In an attempt to verify the transferability of their results to a Central European population, the authors measured the length of the sagittal and coronal sutures with a tape measure along with body height in the course of 117 autopsies performed at the Institute of Forensic Medicine at the University of Giessen during 2009 and 2010. The age of the individuals measured ranged from 15 to 96 years (mean value 52.8, median 51 years). Of these individuals, 82 were male and 35 were female. The length of the sagittal suture with respect to body length yielded a correlation coefficient of only r = 0.045 (p = 0.617) in the regression analysis. Similar results were found for the coronal suture: In this case the correlation coefficient was r = 0.015. With an assumed maximum permissible probability of error of α = 0.05, none of the performed regression analyses were found to be statistically significant. As expected, our results suggest that neither the length of the sagittal nor the length of the coronal suture is suitable for a forensic estimation of stature for Central European individuals.

[On the value of tattoos for identifying unknown bodies - a retrospective study of forensic autopsy cases from Giessen, Germany]. / Über den Wert von Tätowierungen zur Identifizierung Verstorbener am Beispiel gerichtlicher Leichenöffnungen im Institut für Rechtsmedizin Gießen.

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.

A literature study on the definition and history of the term "kidney shrinkage".

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.

[Alleged suicide by insulin]. / Vermeintlicher Suizid durch Insulin.

A 26-year-old man, who was on probation, was found dead in his home by his mother. Insulin vials and 2 insulin pens, which the man's stepfather (an insulin-dependent diabetic) had been missing for over a week, were found next to the deceased. The circumstances suggested suicide by an injected insulin overdose. At the time of the autopsy, the corpse showed already marked signs of autolysis. Clinical chemical tests confirmed the injection of insulin, but indicated hyperglycemia at the time of death. Toxicological analyses revealed that the man had consumed amphetamine, cannabinoids, and tramadol in the recent past. Histological examination finally revealed extensive bronchopneumonia as the cause of death. The most plausible explanation for the results of the autopsy and the additional examinations was an injection of insulin as a failed attempt of self-treatment. It is conceivable that the man had discovered by a rapid test that he was a diabetic, but had decided not to go to a doctor to avoid disclosure of parole violation due to continued drug abuse. He may have misinterpreted the symptoms caused by his worsening bronchitis and the developing bronchopneumonia as symptoms of a diabetic metabolic status and may have felt compelled to treat himself with insulin.

[Sauna deaths in Hesse, Germany, between 1994 and 2014]. / Saunatodesfälle in Hessen 1994-2014.

Due to the high ambient temperature, sauna deaths show a few confounding particularities, such as an accelerated onset of the postmortem changes, that can make correct assessment of the manner of death difficult and severely constrain the accuracy of post- mortem interval estimates. This retrospective study, performed at the medicolegal institutes in Hesse, Germany, reviewed all autopsy reports from the years 1994-2014 for sauna-related deaths. 9 relevant cases were found involving one woman and eight men aged between 52 and 80 years (mean and median value: 67 years). Of the individuals who had died of a natural cause, four were found to have had coronary heart disease, which, in the setting of heart hypertrophy and exposure to high temperatures, ultimately led to cardiac failure. In three other cases, a non-natural cause of death had been diagnosed; however, all were attributable to accidents. In two of these, blood alcohol concentrations (BAC) of over two per mil were found. In our opinion, the manner of death should be classified as undetermined in sauna-related fatalities. Such cases require a court-ordered autopsy to reliably identify the actual cause of death.

[Pre- and perimortem bone trauma vs. postmortem damages-- Principles of differentiation]. / Prä- oder perimortale Knochentraumata vs. postmortale Defekte--Grundlagen der Differenzierung.

In medicolegal practice, evidence of trauma or damage on human skeletons or single bones raises the question whether this was inflicted in an antemortem, perimortem, or postmortem time frame. Trauma that occurred around the time of death, i. e., perimortem trauma, is of special forensic interest, as it can yield clues about the manner and cause of death. Perimortem traumas thus need to be carefully distinguished both from antemortem injuries that were evidently survived (these can still be useful for identification purposes) and from postmortem damage, as may occur during retrieval of remains. This study offers an up-to-date review of the specialist literature, e. g. textbooks and pubmed-listed publications, identifying differentiation criteria for ante- and perimortem traumas and postmortem damage. The results that are useful for practice in actual medicolegal casework are presented, and an overview of all macroscopically visible criteria (including simple magnifications, i. e., magnifying glass) that can be used to distinguish between ante- and perimortem traumas on the one side, and postmortem damage on the other is given. The difficulty of distinguishing antemortem trauma and postmortem damage from perimortem trauma rises sharply the closer in time they were inflicted to the time of the death event. Additional postmortem changes due to exposure of the bones to the surrounding deposition conditions may also occur after the relevant postmortem damage or antemortem trauma was inflicted and further complicate the problem. In this context, the "perimortem interval" and the "Fracture Freshness Index" (FFI) are discussed as means to classify the time frame of traumas.

Molecular identification of fungi found on decomposed human bodies in forensic autopsy cases.

To investigate which fungi can be found during forensic autopsies, a PubMed literature review was done in regard to fungal growth on decomposed human bodies. Unfortunately, the existing data is limited and not all fungi were identified to the species level. We, therefore, collected skin samples with macroscopically visible fungal growth from 23 autopsy cases in Germany and identified the fungi to the species level by molecular methods. The identified species included Aspergillus fumigatus and Candida albicans, which pose an allergenic risk, especially to persons with underlying lung diseases. Because safety standards are lacking, we recommend the use of respiratory protection during exhumations and forensic autopsies, when fungal growth is noted. With regard to the future, a database was set up which could possibly be used as a forensic tool to determine the time of death.