[Drowning in the bath tub after choking: Unusual death, accident or suicide? Reconstruction of an unusual fall]. / Ertrinken in der Badewanne nach Drosseln: Fremdtötung, Unfall oder Suizid? Rekonstruktionsversuch eines aussergewöhnlichen Falles.

A thirteen-year old girl attending a special school who had been suffering from genuine epilepsy for about one year was found dead completely clothed in the full bathtub in the bathroom of her parent's flat. The characteristic features of death by drowning but also signs of strangulation as well as a condition after shackling of the hands were found in the forensic post-mortem examination and autopsy. The putative strangulation instrument was a pair of tights which was floating in the bathwater. The hands were probably tied with the lace of a sneaker. In the further course of events, the inquiries and investigations initially commenced on the assumption of a capital crime gave reason to consider suicide. A reconstruction experiment under comparable external conditions indicates that this is possible. From a forensic-psychiatric point of view, an exacerbative mental crisis situation can be inferred as a final motive from the known personality configuration and the immediate circumstances. The tragic outcome in the final phase appears to have been determined by the additional complication of a provoked grand mal epilepsy attack. All in all, this hypothesis is the most plausible. However, subjective and objective observations do not rule out the possibility of homicide.

A mathematical analysis of creatine kinase activity in the course of Duchenne muscular dystrophy.

Recently, clinical follow-up studies have shown that the age of first symptoms and the speed of progress may vary considerably in Duchenne muscular dystrophy (DMD). Prognostic factors would be of interest not only for the patients themselves, but also for the selection of DMD patients for therapeutic studies. Creatine kinase (CK) activity reflects the dystrophic degeneration of the muscle cells. Therefore, the coherence of the course of CK activity and its relationship to the clinical state was investigated with the aid of a heuristic mathematical formula. Two constants were calculated, b and c. The data of 88 DMD patients proved the validity of the mathematical formula. Constant b seemed to be of no clinical relevance. The height of constant c was related to the age at which the ability to walk was lost (r = -0.76). This constant provides an objective individual assessment of the prognosis in DMD. In addition, the mathematical analysis of the CK course opens the way for a prospective CK estimation, which is relevant for the evaluation of therapeutic trials.