[Clinical forensic examination findings and legal outcome in cases of suspected physical child abuse]. / Klinisch-forensische Untersuchungsergebnisse und rechtliche Folgen bei körperlicher Kindesmisshandlung.

Clinical forensic examinations performed at the Institute of Legal Medicine of the Hanover Medical School between 1999 and 2008 in cases of suspected physical abuse of children were analyzed retrospectively with special emphasis on the legal consequences. Altogether, 192 children (85 girls, 107 boys) with a median age of 4.4 years were examined. In 47 cases (24.5 %), the clinical forensic examination findings were interpreted as accidental injuries, birth traumas or unspecific findings. 29 victims (20.0 %) had suffered a shaken baby syndrome. Only part of the presented cases ended with conviction, which was more likely if the victims were aged between 7 and 11 years. Prison terms of 2 years and more were imposed only if the child suffered potentially or acute life-threatening injuries or if additional anogenital lesions were diagnosed indicating sexual child abuse.

[Clinical forensic examination findings and legal outcome in cases of suspected sexual child abuse]. / Klinisch-forensische Untersuchungsergebnisse und rechtliche Folgen bei sexuellem Kindesmissbrauch.

The clinical forensic examinations conducted at the Institute of Legal Medicine of the Hanover Medical School between 1999 and 2008 in cases of suspected sexual abuse of children were evaluated retrospectively and analysed with regard to their legal outcome. In total, the study included 223 children (172 girls, 51 boys) with a median age of 8.6 years. In 34 children (15.2%), forensically relevant diagnostic findings due to anogenital injury and/or detection of semen were recorded. Perpetrators were convicted more often when they were not a member of the victim's family. In cases with victims aged seven years or older, conviction was more common. The study shows that medical findings can best be preserved by an immediate clinical forensic examination. Suspected sexual child abuse can often not be proved by medical examination results, but in some cases diagnostic findings are not mandatory for conviction.

[Placental findings in perinatal cases of death]. / Plazentabefunde bei perinatalen Todesfällen.

Autopsy is an indispensable tool to clarify the cause of death in perinatal cases of death. The authors report on two cases of perinatal death, in which not only a forensic autopsy including histological and microbiological examinations had been performed, but the placenta had also been pathologically assessed. Only on the basis of the placental findings was it possible to clarify the cause of death and to answer the question if the physician had committed medical malpractice. The results underline the importance of examining the placenta in perinatal deaths as a matter of routine. In forensic cases, the police should therefore not only confiscate the infant's body, but also the placenta.

[Post-mortal detection of clostridia--putrefaction or infection?]. / Postmortaler Nachweis von Clostridien--Fäulnisbakterien oder Infektionskeime?

Clostridia are often found in the heart blood and organs of corpses showing putrefactive changes, and it can sometimes be difficult to distinguish between an ante-mortem infection caused by these gram-positive, anaerobic, spore-forming bacteria and post-mortal putrefactive changes. Microbiological tests ordered by the Institute of Legal Medicine of the Hanover Medical School following autopsy between July 2006 and June 2009 were analyzed retrospectively. In all, 50 bacteriological analyses were performed. In 2006, no clostridia were detected, whereas in 2007 the bacteria were demonstrated in 3 (18.8%), in 2008 in 4 (23.5%) and in 2009 in 5 (33.3%) cases. In 50% of the cases, there had been an ante-mortal clostridia infection. The remaining 50% were due to post-mortem transmigration of clostridia species. The results of this study underline the importance of additional post-mortem bacteriological and histological investigations.

[Analysis of clinical forensic examination reports on sexually abused children]. / Analyse der Untersuchungsergebnisse bei sexuellem Kindesmissbrauch.

Clinical forensic examinations of children suspected of having been sexually abused are increasingly part of the routine of medicolegal institutes. The findings collected from 2005 until 2007 at the Institute of Legal Medicine of the Hanover Medical School were analysed retrospectively. Altogether, 91 children (74 females, 17 males, mean age 8.7 years) were examined. In 87.9% of the cases, the examination had been ordered by the police. In 73.6%, the victim knew the suspected perpetrator well or he was a family member. 40.7% of the children were seen within 72 hours after the alleged abuse. 12.1% of the children had extragenital lesions. In 27% of the victims, marked anogenital injuries were found, which were characteristic of sexual abuse in 9%. In 18 cases (20.2%), swabs were taken for spermatozoa detection. 3 of 17 vaginal smears showed positive test results for sperm up to 21 hours after the incident. No spermatozoa could be detected in 4 anal and 2 oral swabs as well as in one swab taken from the skin of the victim's thigh. In summary, the evaluation shows that early clinical forensic examination of children suspected of having been sexually abused is crucial to document evidence that is highly significant for the investigation and court proceedings. Often suspected sexual child abuse cannot be proved by medical findings alone. Of course, the absence of anogenital injuries does nor rule out sexual abuse.

Analysis of clinical forensic examination reports on sexual assault.

Medical-forensic examination of sexual assault victims and alleged offenders is a common task of many forensic institutes. In the current study, the results from samples taken at the Institute of Legal Medicine, Hanover Medical School, during a period from 2005 to 2007 were retrospectively evaluated. In total, 292 victims (283 females and nine males) and 88 suspects were examined. At the time of the assault, 41.8% of the victims and 43.2% of the alleged perpetrators were under the influence of alcohol. Injuries were found in 84.9% of the victims and 39.8% of the suspects. Thirty victims (10.3%) reported having been choked or strangled. Cytology was performed in 218 victims. In 81 cases (38.0%), sperm could be detected in vaginal swabs up to 3 days post-assault. In seven (18.9%) out of 37 anal samples, evidence of sperm could be found 24 h post-assault. None of 22 oral samples was positive for sperm. Out of 301 sexual assault cases, 171 could be proved by means of medical-forensic examination. In summary, our evaluation shows that an early medical-forensic examination of both victim and suspect can secure numerous medical findings. Furthermore, persons intoxicated by alcohol, handicapped persons and persons with psychiatric disorders are more vulnerable to become a sexual assault victim.

[Postnatal sepsis due to group A Streptococcus in a mother and her newborn]. / Postnatale Sepsis bei Mutter und Kind durch Streptokokken der Gruppe A.

Nowadays, postnatal sepsis caused by group A Streptococcus (Str. pyogenes) is a rare condition. However, the mortality due to this uncommon disease is still high, and it has been described in the literature more frequently in the last few years. The authors present the case of a female newborn who died 15 hours after spontaneous delivery in the 40th week of gestation. Autopsy revealed a lung edema and solid lung parenchyma with normal findings of the other organs on macroscopic examination. Additional bacteriological testing detected Streptococcus pyogenes in the child. Aspiration pneumonia and signs of sepsis were discovered in the histological examination. Three days postpartum, the mother was hospitalized with Streptococcus pyogenes sepsis. Streptococcus pyogenes colonization of the mother's vaginal flora was assumed to be the origin of the infection. The problem in this case was the macromorphological diagnosis of sepsis and pneumonia in the newborn. The importance of microbiological analysis as a matter of routine is emphasized.