[Fatal flecainide intoxication in a 17-year-old girl]. / Tödliche Flecainidintoxikation eines 17-jährigen Mädchens.

A 17-year-old girl was found vomiting and somnolent at home and was taken to a hospital. The girl initially presented with ventricular tachycardia with broad QRS complexes which was very difficult to control. During the course a subsequent cardiogenic shock developed and despite exhaustion of all therapeutic options the fatal outcome could not be averted. The medicolegal autopsy revealed no evidence of any form of violence but the signs of medical treatment. Furthermore, no pathology of internal organs was detected. The toxicological analyses revealed a lethal intoxication with flecainide as the cause of death. The investigations of the police indicated that the girl took flecainide in suicidal intention.

Renaissance of criticism on the concept of brain death--the role of legal medicine in the context of the interdisciplinary discussion.

BACKGROUND: In the practice of legal medicine in Germany, the assessment of brain death is of minor importance and attracts little attention. However, since several years, international criticism on the concept of brain death has culminated. By reviewing literature and the results of a questionnaire distributed among the participants of the 93rd Annual Congress of the Germany Society of Legal Medicine, the state of knowledge and the current views on brain death were evaluated. MATERIALS AND METHODS: Literature search of recent publications regarding brain death was performed (PubMed database, references of legal medicine, Report of the President's Council on Bioethics, USA 2008). A questionnaire was developed and distributed among the participants of the Congress. RESULTS: The assumption that individual and brain death are synonymous is criticized. Internationally, there are trends to harmonize the very different clinical criteria to assess brain death. The diagnostic advantage of novel techniques such as CT angiography is controversially discussed. It becomes apparent that procedures which record the blood flow and perfusion of the brain will be applied more in the future. Regrettably, these developments are not described in the literature of legal medicine. Moreover, among German forensic scientists, different views concerning brain death exist. The majority favors its equivalent treatment with individual death. The thanatological background can be improved concerning certain aspects of brain death as well as its legal implications. CONCLUSION: Teaching and research in legal medicine should include the subject brain death. Expertise in forensic science may contribute to the interdisciplinary discussion on brain death. The transfer of actual knowledge, also on disputed ethical aspects of thanatology, to physicians of all disciplines is of great importance.

[Mason's lacing cord. Potential danger of severe open ocular injuries]. / Maurerschnüre. Potenzielle Gefahr für schwere offene Augenverletzungen.

BACKGROUND: Introduction of new working equipment or the modification of established working routines could induce new trauma mechanisms. In all of theses cases ophthalmologists are not only responsible for ocular treatment they also have to act as assessors. This might include legal aspects, e.g. to validate the circumstances of an accident. METHODS: We present a new trauma mechanism caused by a mason's lacing cord which was fixed with nails. In addition to two case studies we collected experimental data (maximum tension and maximum elongation of various mason's lacing cords) about the triggering event using standard test conditions. RESULTS: A tensile force of 96.2 N was needed to achieve maximum elongation of mason's lacing cords. With a cord length of 5 m, an elongation of 0.09 m was enough to cause penetrating injuries (for 10 m cord length the critical elongation was 0.13 m). Under these conditions a nail could be accelerated to a velocity of 18 m/s. This may lead to open eyeball injuries with severe visual loss. CONCLUSIONS: Nails fixed to elastic mason's lacing cords are potential risk factors for occupational ocular injuries and severe loss of vision. Caution labels should be attached to the work equipment and proper eye protection should be used to prevent severe occupational ocular injuries.

Petechial bleedings in sudden infant death.

The autopsy reports of 484 cases of deceased infants (201 females, 283 males) were analysed retrospectively for the existence of external and internal petechial bleedings (PET). The cases were divided into five groups on the basis of the cause of death (sudden infant death syndrome, sepsis, airway infections, asphyxia and trauma). Internal PET (pleural, pericardial, epicardial, thymic and peritoneal) were observed in each group with a lower prevalence in cases of trauma. The highest prevalence of external (cutaneous and conjunctival) PET was detected in cases of asphyxia (38% and 31%, respectively). However, even if with low prevalence, such bleedings were detected in every group. Factors like sex, age, cardiopulmonary resuscitation and its duration did not influence the presence of PET. The detection of external PET at autopsy is a suspicious finding that suggests asphyxia. Because of the possible natural origin of these bleedings, the medicolegal investigation has to be as complete as possible and has to include histology as mandatory.

Ballistic parameters of cal. 9 mm x 17 mm industrial blank cartridges (cattle cartridges).

INTRODUCTION: Cal. 9 mm x 17 mm industrial blank cartridges deserve special interest in the field of forensic ballistic. This calibre is most often used in Kerner-type livestock stunners, but also in different power tools. The legal framework of these industrial blank cartridges is provided by the C.I.P. and DIN 7260 regulations. The aim of this investigation is to describe and compare two experimental test procedures for measurement of maximum gas pressure and kinetic energy of cal. 9 mm x 17 mm industrial blank cartridges according to standardized C.I.P. and DIN 7260 protocols and to provide these ballistic data. METHODS: Using two different pressure measurement barrels and standardized test projectiles, the maximum gas pressure and the kinetic energy of the test projectiles are investigated. While the pressure take-off point in C.I.P. protocol is at the cartridge mouth, the DIN 7260 protocol is modified using a pressure take-off point in the cartridge chamber. For each test protocol (C.I.P. and DIN), maximum gas pressure, velocity, impulse and energy of the test projectiles are measured. Each ten cartridges from the same ammunition lot of four different energy levels (red, blue, yellow, green) are investigated. RESULTS: While the cartridge energy values are comparable between the two different test protocols, maximum gas pressure measured in the DIN set-up (3907 bar) far surpasses the gas pressure in the C.I.P. protocol (1586 bar). Both test protocols observed higher energy values of the green and yellow cartridges than regulated in DIN 7260. CONCLUSION: Enormous gas pressure values of more than 3900 bar emphasize the power of industrial blank cartridges. Once again, the harmlessness of these blank cartridges and the weapons/tools that are operated with these propellants is refuted.

Dynamic pressure measurement of cartridge operated vole captive bolt devices.

INTRODUCTION: Vole captive bolt devices are powder actuated spring guns that are used as a pest control mean. After having triggered the explosion of the blank cartridge by touching a metal ring around the muzzle, the vole is killed by the massive propulsion of the gas jet. Improper use and recklessness while handling these devices may cause severe injuries with the hand of the operator at particular risk. Currently, there are no experimental investigations on the ballistic background of these devices. METHODS: An experimental test set-up was designed for measurement of the firing pressure and the dynamic force of the gas jet of a vole captive bolt device. Therefore, a vole captive bolt device was prepared with a pressure take-off channel and a piezoelectric transducer for measurement of the firing pressure. For measurement of the dynamic impact force of the gas jet an annular quartz force sensor was installed on a test bench. Each three simultaneous measurements of the cartridges' firing pressure and the dynamic force of the blast wave were taken at various distances between muzzle and load washer. RESULTS: The maximum gas pressure in the explosion chamber was up to 1100 bar. The shot development over time showed a typical gas pressure curve. Flow velocity of the gas jet was up to 2000 m/s. The maximum impact force of the gas jet at the target showed a strong inverse ratio to the muzzle's distance and was up to 11,500 N for the contact shot distance. Energy density of the gas jet for the close contact shot was far beyond the energy density required for skin penetration. CONCLUSION: The unique design features (short tube between cartridge mouth and muzzle and narrow diameter of the muzzle) of these gadgets are responsible for the high firing pressure, velocity and force of the gas jet. These findings explain the trauma mechanics of the extensive tissue damage observed in accidental shots of these devices.

Factors and circumstances influencing the development of hemorrhages in livor mortis.

Petechial hemorrhages or ecchymoses in the skin of the face and/or in eyelids and/or conjunctivae are one important feature in postmortem diagnosis of lethal strangulation. On the other hand, petechial bleedings can occur in various causes of death, especially in cases of neck or thoracic compression, they can occur in acute cardiac failure, as a result of blood or skin diseases or as a postmortem phenomenon. The focus of this investigation (retrospective study of 279 corpses, found initially in a prone position or some other face down position) was to analyse the frequency of postmortem (hypostatic) hemorrhages and factors which may influence their development. Petechial hemorrhages in livor mortis in the skin of the trunk and extremities were found in 110 cases (39%). The frequency ranged from 41% in the side position and 44% in the kneeling position to 50% in the prone position. Increasing intensity of livor mortis resulted in an increasing frequency of hemorrhages, up to 59%. In cases with a body-mass-index (BMI) of more than 26 the frequency of hemorrhages increased up to 64%. In cases without livor mortis when the corpses were found as well as in cases with complete movement of livor mortis after turning the corpses, no hemorrhages were found. If hypostasis was partly or completely fixed, the rate of hemorrhages increased up to 50%, without additional increase in longer postmortem intervals. Obviously postmortem petechiae develop neither very soon nor days after death, but within a period of several hours after death.

Suicide through doxylamine poisoning.

Doxylamine is an antihistamine of the ethanolamine class. It is used primarily as a sleep-inducing agent. Only a few reports can be found in the literature about lethal intoxications with doxylamine, but many with combined intoxications. Doxylamine is, aside from diphenhydramine, the only chemically defined active ingredient in some sleeping medications which is available without a prescription in the Federal Republic of Germany. Two cases of doxylamine poisoning are presented, in which high doxylamine concentrations were found in the blood and organs.

Medical studies and training duration for forensic pathologists in Germany.

This article gives a short overview of medical education in Germany. The legal basis and organization of the medical studies program as well as the course in forensic medicine and the training duration for forensic pathologists are described.

[Cervical findings and petechial hemorrhages in falls from high positions]. / Uber Halsbefunde und petechiale Blutungen beim Sturz aus der Höhe.

Cases of combined suicide are infrequent findings, especially cases in which each method can be lethal. In interpretation of cases with a multitude of serious injuries it might be impossible to discover minor injuries which had occurred in the course of a preceding confrontation, because they may be masked by the general traumatization. In two cases of suicidal fall from a height neck injuries and petechial bleedings were found. The first case (woman 53 years) was a combination suicide (strangulation by ligature, deep incisions into her wrists, jump out of the window). The intensive petechial bleedings in the face could be explained as a result of ligature strangulation and the fracture of a lower thyroid horn as an indirect fracture resulting of the head traumatization. In the second case (girl, 14 years) petechial bleedings in the face were found. Furthermore the victim had marks on her neck-skin, consisting of well-lined bleedings and scratches, presenting a clear pattern, which could be related to a necklace. An explanation of these injuries as a result of a direct impact could not be given. Something must have happened prior the fall. Informations concerning the last hours before her suicide could not be obtained but a strangulation-attempt (by herself? by others?) must be ascertained. The histological investigation of the skin of this region arised a negative vital reaction, therefore a very short interval between that event and the death was assumed.

Phenotype change in polymorphic plasma proteins following liver transplantation.

In 7 patients who received liver transplants, 12 plasma proteins were subjected to phenotype analysis in donor and recipient before and after transplantation. The plasma proteins analyzed were haptoglobin, transferrin, glycoprotein GC, alpha-1-antitrypsin, complement factor 3 (C3), orosomucoid 1, properdin factor B, complement factor 6, alpha-2-HS-glycoprotein (A2HS), plasminogen, factor B of coagulation factor XIII, and interalpha-trypsin-inhibitor (ITI). Classification was done with isoelectric focusing or agarose gel electrophoresis (C3). A change from recipient to donor type was observed for all systems with the exception of C3. This is the first time such data have been obtained for the A2HS and ITI systems. The time is indicated at which the recipient type disappeared and the donor type appeared. In addition to the expected phenotype changes from recipient to donor type, unexpected results were found in some systems. For instance, in 2 patients a mixed type was synthesized, or new phenotypes appeared. Possible explanations include blood transfusions, immunosuppressive therapy, extrahepatic sites of synthesis and disturbed transplant function. The usefulness of phenotype determination as a diagnostic criterion for transplant function is discussed.