[Traumatic splenic rupture--fatal increase in thrombocytes after splenectomy]. / Traumatische Milzruptur--fataler Thrombozytenanstieg nach Splenektomie.

A patient with CMGM developed after traumatic splenectomy a severe thrombocytosis up to 4 millions. 25 days after the accident he died of acute right heart failure caused by vascular occlusion of lung vessels due to thrombocyte aggregations. According to the regulations of professional cooperatives in Germany the death is caused by the occupational accident. A bereaved pension will be payed. For the private life insurance the blood disease is with 33% partial responsible for the fatal development and reduces the payment. According to german penal law the death of the victim will tighten the punishment, if someone else is guilty for the accident. A professional error on the part of a doctor is not provable.

[Accidental death in advanced age]. / Unfalltod im höheren Lebensalter.

In 1989 accidental death of 72 persons with an age of at least 60 years were determined at the Institute for Legal Medicine in Hamburg. 41 of them (57%) died by traffic accident. In those cases 18 of them died from pneumonia or embolism of lung as a result to be laid low. The causal connection and phenomenoms of those complications are described and problems of medicine, social-security payment and insurance benefit of the elder age are discussed.

HIV-infection in the autopsy material (Hamburg 1984-1989).

77 HIV-positive corpses were autopsied at the Institute of Forensic Medicine in Hamburg (in cooperation with the Bernhard-Nocht Institute) from August 1984 until September 31st, 1989. In the clinical autopsies (29 cases) the patients had always shown manifest AIDS symptoms, while 90% of the HIV-infected forensic autopsy cases had no AIDS symptoms during their lives and mostly died from drug overdose. Authors describe the clinical autopsy findings (Kaposi sarcoma, infections caused by opportunistic pathogenics), serological AIDS screen-examinations, and the precautions applied during the autopsies. They also describe their own methods for the prevention of infection with reference to hygiene in the dissecting rooms.

Intensive gunshot residues at the exit wound: an examination using a head model.

The autopsy findings of intensive gunshot residues at the exit wound after a gunshot wound in the head led to an experimental investigation to clarify the mode of origin and intensity of these gunshot residues on the inner surface of the exit wound. For this purpose a simple skull/brain model was prepared. The results of the examination showed that with weapons of the same calibre distinct gunshot residues should be expected at the exit wound.

[Causes of and circumstances in death due to subdural hematoma]. / Ursachen und Umstände des Todes bei subduralen Hämatomen.

This study concerns lethal subdural hematomas in the autopsy material at the Institute of Forensic Medicine of the University of Hamburg (n = 102; 0.9% of 11,462 autopsies 1980 to 1988). 63 fatalities were male (mean age 46 years) and 39 were female (mean age 53 years). Subdural hematomas were predominantly located parietotemporal (64%) and had an average volume of 125 ml. Rupture of the bridging veins and contusions of the cerebral cortex were frequent sources of bleeding. In one third of cases the exact topographical site of bleeding was not determined. 90% of the subdural hematomas were of traumatic origin, two thirds had an acute clinical course of less than twelve hours; 23 times neurosurgical intervention took place. With respect to the criminal and civil law it is of decisive significance to explain the causal relationship between subdural hematomas and preceding trauma. Recently there is an increase in blame against physicians in cases where the subdural hematoma (e. g. of inebriated persons) was not diagnosed and treated immediately.

[Asbestos screening of autopsy material]. / Asbest-Screening im Autopsie-Material.

UNLABELLED: This study was designed to provide basic data on the deposition of asbestos in human tissue in an urban area (Hamburg) with increased immission rates of fibres. The analysis of the unselected autopsy cases was carried out by light microscopy counting the typical asbestos bodies (method: wet digestion of tissue and filter technique). - RESULTS: a) The average concentration of asbestos bodies (AB) per ccm lung tissue (n = 80) amounts to 35 AB/ccm (men 38 AB/ccm, females 15 AB/ccm). b) Asbestos bodies could be found regularly in extrapulmonary tissues (n = 20, up to 13 different tissue samples per case), most frequently in lymph nodes, thyroid gland and spleen. c) Lungs of children in the age of 7 to 16 years (n = 40) showed asbestos bodies in 35% of the examined cases (with a range from 3 to 31 AB/ccm lung tissue).

[Carbon monoxide poisoning in the automobile--suicide or accident?]. / CO-Vergiftung im Pkw--Suizid oder Unfall?

In cases of CO-poisoning in vehicles accidents have to be reviewed. Old automobiles or untypical discovery without manipulations have circumstantial evidence. This proceeding is demonstrated by two casuistries. The argumatative force of the first appearance is not sufficient to give reasons for private-law consequences.

[Suicide by 120 stab wounds of the chest?]. / Suizid durch 120 Bruststichverletzungen?

The case history of a suicide due to 120 stab wounds of the chest is presented. The victim was a 41 years old man with a paranoid-hallucinative psychosis. The problem to distinguish homicides and suicides is discussed by the well-known criminalistic and forensic-medical criterias. Induced by this very unusual case the autopsy material with stab wounds was analyzed retrospectively (n = 246, out of about 14,000 autopsies at the Institut of Forensic Medicine in Hamburg). Cases with more than 40 single lesions are normally homicides. However, the pattern of the injuries is more important than the number--especially in doubtful cases.

HIV-infection in forensic autopsy cases.

Sudden and unexpected death and violent death of persons with a high risk of acquiring HIV-infections, especially homosexual males and intravenous drug abusers, have to be investigated by forensic autopsies. Therefore every forensic pathologist has to be aware of this infection and should try to make the proper diagnosis. Three typical cases are described: (1) suicide by hanging, (2) homicide by cutting the throat and (3) intravenous heroin overdose. Merely retrospectively it could be cleared up that the deceased were homosexual but did not manifestly suffer from AIDS. The morphological findings in the lymph nodes and the postmortem serological findings are described in detail.

[Unusual intimal and endocardial damage following suicidal infusion of thiobutabarbital]. / Ungewöhnliche Intima- und Endokardschädigung nach suizidaler Infusion von Thiobutabarbital.

A suicide is reported that was carried out by i.v. infusion of thiobutabarbital. The most impressive findings were macroscopical alterations in the venous endothelium, the endocardium of the right atrium and ventricle, and the endothelium of the pulmonary artery. The same local cytotoxic side effects could be reproduced in animal experiments. The lesions are most striking after circulatory stagnation in the agonal and supravital period when highly concentrated thiobarbiturates come into contact with the endothelium.

Ultrastructural alterations of skeletal muscles after electric shock.

The existence of tracks of electric current in the skeletal muscles was checked by electron-microscopic investigations in animal experiments on rats. Hypercontraction bands alternating with dilated sarcomeres and tumefaction of tubular apparatus and mitochondria with cristiolysis were established. The most severely expressed alterations were found in the vicinity of the electrodes and adjacent to the joints; they are thought to be caused by electrically induced tetanus and local hyperthermia. The forensic aspects of these findings are discussed.