Tooth aspiration: its relevance in medicolegal autopsies.

Tooth aspiration in adulthood is an uncommon autopsy finding. The paper presents two cases in which maxillary incisors had been avulsed and inhaled during hospital treatment and in the course of maxillofacial trauma, respectively. In the first case, repeated attempts to remove the aspirated tooth by means of flexible bronchoscopy led to perforation of the bronchial wall with consecutive bleeding into the deep airways and fatal asphyxia. In the second case, the fact of tooth aspiration remained undetected throughout the 3-day survival time until death from craniocerebral trauma. The paper points out the forensic aspects of tooth aspiration against the background of the relevant clinical literature.

Simulation of an assault with self-tying and vaginal insertion of metal objects.

Report on a recent case, in which a 28-year-old woman was found tied in her flat by her son who called the police. When the police arrived, the woman was lying on the floor fully conscious. The face and upper chest, the arms and legs were wrapped with broad adhesive tape. After the police had cut the tapes, she stated that she had been attacked by two men who demanded a large amount of money and made her unconscious by pressing a strange smelling cloth against her mouth. In the course of the gynaecological examination, several teaspoons and pieces of jewellery were found in her vagina. Neither the genital region nor the other parts of the body showed any injuries. When she was confronted with the results of the medicolegal examination, she admitted self-infliction for the purpose of simulating an offence.

[A case of fatal amniotic fluid embolism]. / Zur Kasuistik der letalen Fruchtwasserembolie.

A 31-year-old pregnant woman (multipara), who was near the expected date of birth, was found dead in the joint flat by her partner. She was lying beside the bed and showed burns on the front of the body caused postmortem by contact with a radiator. Autopsy revealed a rupture of the fetal membranes, the inner layers of the uterus and a large vein. After centrifugation, the supernatant of the blood from the right half of the heart was turbid and contained small corpuscular amniotic fluid components. The diagnosis of amniotic fluid embolism could be confirmed histologically. In the pulmonary vessels of the mother meconium, lanugo hairs and epidermic scales could be demonstrated; in addition the fetal horny lamellae were confirmed immunohistochemically (using monoclonal antibody against cytokeratin).

[Plastic bag as the method in suicide and homicide]. / Plastikbeutel als Mittel der Selbst- und Fremdtötung.

The report describes a suicide and a homicide by suffocation in a plastic bag. Both cases were copy-cat acts. The suicide copied the method--taking medicines and pulling a plastic bag over his head from a personal model. In the homicide the perpetrator followed the example of a film sequence from the US feature film "Charade".

[Death caused by accidental hanging in the hand strap loop of a garage door]. / Tod durch unfallmässiges Erhängen in der Handschlaufe eines Garagentores.

The authors report on a 10-year-old boy who accidentally hanged himself in the hand strap of a garage door. The door was an electric overhead door of an underground garage. The accident was reconstructed at the scene using a dummy. The strap of the door was long enough to be slipped over the head easily. In view of this background it seems advisable to consider whether the current safety regulations on the operation of electric doors should be changed accordingly.

[Alcohol stove as a source of CO poisoning in a camper]. / Spirituskocher als Quelle einer CO-Vergiftung im Wohnmobil.

Although the number of deaths from fatal CO poisoning has strongly declined since the change from coal gas to natural gas, accidental and suicidal carbon monoxide intoxications still have to be expected. In motor vehicles the exhaust gases from the engine and a stationary heating are the major sources of intoxication. In closed campers and caravans the operation of gas and spirit cooking stoves etc. may also lead to an accumulation of carbon monoxide due to incomplete combustion.

[Wound entry findings of animal anesthesia guns without smoke outlets]. / Einschussbefunde bei Verwendung von Viehbetäubungsapparaten ohne Schmauchabzugskanälchen.

Subsequent to previous reports on the morphology of injuries from slaughterer's guns a case of suicide with atypical entrance wound findings is reported from the Freiburg autopsy material. The livestock stunner used did not have the smoke conduits usually opening into the muzzle end. Accordingly the entrance wound was not associated with any roundish or elliptic soot deposits. In cases where a large entrance hole without paired or cloverleaf-shaped zones of blackening, but no exit wound and no projectile is found one should also think of a slaughterer's gun without smoke conduits. The results of our test shots with conventional livestock narcotic devices and stunners without smoke conduits are presented.

[Appearance of injuries caused by machetes and unusually large knives]. / Erscheinungsformen von Verletzungen durch Macheten und ungewöhnlich grosse Messer.

Machetes (Spanish-American matchets) are sharp, long knives with a broad blade having a slightly curved edge and a thick back. They are used for clearing paths in rough, densely wooded areas. Just like axes and swords they are suitable for causing not only soft tissue wounds, but also deep slashes in the underlying bone. In military conflicts (especially in Central Africa) they are often used as short-range weapons, whereas it is in the nature of things that they are rarely used in Europe. On the basis of 5 cases from the Freiburg material fatal and survived injuries caused by machetes and similarly large knives are discussed. In 2 cases long chop injuries were inflicted on the head causing sharp-edged transections of the bony skullcap; in one case in which the victim survived a broken off part of the blade lodged in the right os parietale. In another 2 cases complete and subtotal decapitation respectively occurred in the victims. As the instrument can be used both for cutting and stabbing there were not only long cutting injuries, but also gaping stab wounds severing the skin over a length of several centimetres; due to the great length of the blade through-and-through wounds were also seen on the trunk. Massive blows with the thick back of the blade caused streak-like bruising.

[A case of suicidal chloroform poisoning]. / Zur Kasuistik der suizidalen Chloroformintoxikation.

A 33-year-old man who had suffered from phobia and depressions was found dead in his kitchen. He was entirely covered by plastic waste disposal bags stuck together. The corpse was lying flat on his stomach with his face on a towel soaked with chloroform. Within the plastic cover, on either side of the body's head, there was located a can half way filled with chloroform. Autopsy revealed cauterized lips and mucous membranes of the mouth. The morphological findings of the inner organs were unspecific. For toxicological analyses, air samples from the pleural cavities of the corpse were taken by way of charcoal tubes and a microprocessor aided pump. The solvents adsorbed on the charcoal were desorbed with benzyl alcohol and analyzed by gas chromatography according to standard procedures. The quantification of the chloroform levels of the body fluids and the tissue samples of the corpse was performed by extraction with pentane followed by addition of trichloroethylene as internal standard and consecutive gas chromatographic analysis. The results of the toxicological analyses confirmed the diagnosis of a fatal chloroform intoxication.

[Suicide or fatal accident in fantasy play?]. / Suizid oder tödlicher Unfall bei Fantasy-Spiel?

The death by drowning of a 25-year-old man is reported, whose putrescent body was found drifting on the surface of an artificial lake. The deceased was dressed in a coat of chain-mail and trousers of the same material. The chain-mail clothing, which had a weight of 20 kg, reminded one of a knight's armour; it had been made by the wearer himself. Around the neck there were several turns of a chain running down to the legs and tying them together. According to the police investigations it is to be assumed that the man went out on the lake in a rubber boat and then pierced the air chambers of the boat with a knife. The possible background of the case in context with the special liking for fantasy games is discussed.

Complete transection of the trunk of passengers in car accidents.

Traumatic amputation of extremities and complete severance of the trunk have been reported in extra-urban collisions between passenger cars and pedestrians at collision speeds of > 80-100 km/h (50-62 mi/h). In car passengers, such extreme types of injuries are very rare. Two cases are presented in which the cars had a lateral collision with road trees near the right B column (column between front and back door), as a result of which the car was torn into two parts just in front of the rear axle near the back seats. Under these circumstances, the trunk of the back passenger on the side of the collision was completely severed. Both accidents happened in left-hand bends and the speed of collisions amounted to 120 and 180 km/h (74 and 111 mi/h), respectively. All passengers were flung out of the cars.

[Marks on clothing and skin in absolutely and relatively close distance gunshots with fright weapons]. / Befunde an Kleidung und Haut bei absoluten und relativen Nahschüssen mit Schreckschusswaffen.

Based on an actual case to be examined-the victim had sustained burning and powder tattooing of the abdominal skin--test shots were performed with blank cartridge guns (Mauser and Umarex revolvers, cal. 380) in order to study the changes occurring on textiles in the area of contact and close range shots. As expected, the extent of burning and smoke soiling depended on whether the propellant of the blank cartridges consisted of nitrocellulose (Nc) or black powder. At the same distance the smokeless nitro-powder caused less soot soiling and burning than black powder. Contact or near contact shots produced tear-like tissue damages due to the pressure of the discharged muzzle gases. When black powder cartridges were used, burn holes larger than the caliber were observed; with Nc blank cartridges the thermal effects were most pronounced if textiles made of thermolabile synthetics were shot at.

[Fatal gunshot wound injuries with so-called shooting ball-point pens]. / Tödliche Schussverletzungen mit sogenannten Schiesskugelschreibern.

Report on two suicides using shooting ball-point pens (with .22 lr and .22 lr Hv cartridges respectively). Both cases were contact shots (in the first case in the area of the right ear, in the second case in the left temple). Corresponding to the configuration of the barrel end, the muzzle imprints were uncharacteristic (ring-shaped and narrow). The other morphological findings of the wounds did not differ from the injuries inflicted by conventional small-bore weapons.

[Manifestations of screwdriver injuries]. / Erscheinungsformen von Schraubendreherverletzungen.

Report on three homicides, in which apart from other kinds of mechanical traumas there were also injuries due to stabs with a screwdriver; in one case a screwdriver with a cross-shaped tip was used; in the two other cases the weapon was a regular blade screwdriver with a single-edged tip. Supplementing the systematic studies by Brinkmann and Kleiber (Arch. Kriminol. 161, 31-40 [1978]) several other findings concerning screwdriver injuries are reported; non-penetrating impact lesions of the skin with contusion of the underlying subcutis, reddish streaks consisting of intracutaneous hemorrhages in the width of the screwdriver tip (after tangential slipping), bone lesions typical of the tool. If certain locations are hit (e.g. the region of the ear) piercing injuries are also possible. Injuries of the hands show that the victim tried to defend himself and that the stab was inflicted while the victim was still able to act.

[Unexpected fatalities in childhood caused by acute epiglottitis]. / Unerwartete Todesfälle im Kindesalter durch akute Epiglottitis.

Report on two deaths from a natural internal cause in children beyond the first year of life. The children (a two-year and a three-year old boy), who seemed completely healthy, sudden suffered from acute inflammation of the upper respiratory tract with dyspnea, inspiratory stridor, fever, dysphagia, and flow of saliva. The disease took a fulminant course and the children died within a few hours showing symptoms of intense dyspnea and cyanosis. The above symptoms and progress were typical of acute epiglottitis. Autopsy revealed an intense inflammation and tumescence of the epiglottis in both cases. The diagnosis of epiglottitis was confirmed histologically and bacteriologically (Haemophilus influenzae).

[Agonal dog bite injuries]. / Agonale Hundebissverletzungen.

A 57-year-old woman, who was unconscious due to apoplectic cerebral haemorrhage, was injured on the right thigh by dog bites while still alive. In addition to a soft-tissue defect of 10 x 9 x 3 cm (gnawing effect) there were numerous small single lesions in the form of slit-shaped skin cuts. The area around the wounds was discoloured by haematomata. The bite wounds were caused by the mongrel dogs living in the same household (2 parent animals and 6 puppies). The pattern of the injuries corresponded well to the anatomy of a dog's set of teeth.

[Hematoma in acute leukemia--suspected diagnosis of child abuse]. / Hämatome bei akuter Leukose--Verdachtsdiagnose einer Kindesmisshandlung.

A 4-year-old child, suspected of being the victim of child abuse was sent for forensic examination. The examination established multiple, uncharacteristically shaped haematomata in various parts of the body. In addition, petechiae were also present. In view of the nature and localisation of the haematomata and the presence of petechial bleeding a differential diagnosis considered the possibility of a haematological disease and clinical paediatric tests were done to establish the cause, which showed an acute lymphatic leukaemia (ALL) with thrombo(cyto)penia. As haematomata are often the first indication of a leucosis, whenever child abuse is suspected, this possibility should also be considered.

[Fatal intoxication following rectal instillation of alcohol]. / Tödliche Alkoholvergiftung nach rektaler Alkoholinstillation.

A 62-year old man who had been living on a remote farm was found dead in his bed. Inserted in his rectum was a synthetic flexible tube filled with brandy (43 vol. %) and connected to a bicycle pump. Samples taken during autopsy from 3 different parts of the body showed ethanol concentrations from 4.87% to 5.35% in the blood and 6.73% in the urine. The ethanol concentrations in the small and large intestine were considerably higher (more than 29%) than in the stomach (9%). The decreased had a tumor as large as a tennis ball on the base of his tongue, almost completely filling the oropharynx, making swallowing very difficult, which probably was the reason of the rectal instillation of alcohol. The report deals with this unusual case of rectal alcohol instillation, and with the different ethanol and congener alcohol concentrations in the body fluids.

[Histopathologic changes in several opportunistic infections in AIDS]. / Histopathologische Veränderungen einiger opportunistischer Infektionen bei AIDS.

Opportunistic infections are frequent in AIDS patients, particularly in the last phase of the disease, when they occur both singly and in combination with other conditions (for example KAPOSI's sarcoma). These opportunistic infections are the cause of death in over 90% of cases. Their incidence ist proof of cellular immunodeficiency. Based on our observations (17 cases at the two institutes since 1984) we present and discuss the histopathological changes of some important opportunistic infections (notably Pneumocystis carinii pneumonia, Mycobacteriosis (MAI), Cryptosporidium Cytomegalovirus and Toxoplasmosis gondii infection).

Surveillance, prevention and control of hospital-acquired infections. III. Nosocomial infections as cause of death: retrospective analysis of 1000 autopsy reports.

One thousand post-mortem reports were analysed retrospectively to see whether the patient had had a nosocomial or community-acquired infection and whether this led directly to or contributed to the patient's death. In 7.4% of all autopsies nosocomial infection was the direct cause of death. In 6.3% of the patients, nosocomial infection was a contributory factor leading to death. The most common hospital infections were pneumonia, septicaemia, peritonitis, meningitis, and hepatitis B. Most infections which led to or contributed to death were acquired in surgical wards. Patients with nosocomial infections, however, were more endangered by factors predisposing to infections (1.8 factors per patient) than patients without nosocomial infections (0.67 factors per patient). Sixty-three patients acquired an infection outside the hospital; in 70% of these patients, the infection was the main or contributory cause of death.