Estimation of the time since death-Even methods with a low precision may be helpful in forensic casework.

Gold standard for the estimation of the time since death in the early postmortem period is the temperature based nomogram method together with time of death dependent criteria of postmortem lividity, rigor mortis and supravital reactions. There is also a huge literature on chemical methods proposed for estimating the time since death which however play obviously no role in forensic practice. Especially the rise of vitreous potassium has been studied intensively. Also immunohistochemical methods have been proposed for estimating the time since death but obviously not yet applied in casework. We present a case where a woman was found murdered 8 days after having been seen last alive. Due to lack of putrefactive changes postmortem interval was thought to be not more than 2 days. However, immunohistochemical stainings and vitreous potassium concentration revealed that time since death was more than 6 days and the woman was obviously murdered immediately after she was seen lastly alive.

Immunohistochemical methods as an aid in estimating the time since death.

For the estimation of time since death in the early postmortem interval, a large repertoire of valid methods is available. With increasing time since death the estimation of the postmortem interval becomes more imprecise and unreliable because validated methods are missing. Wehner et al. developed a method to estimate the time since death using immunohistochemical staining. Proteins undergo degradation after death and this reduces their stainability. Previous studies have explored the development of a method to estimate the time since death using immunohistochemical staining. A systematic analysis (Wehner et al., 1999-2002) demonstrated that calcitonin can still be stained 4 days, thyreoglobulin 5 days, glucagon 6 days, and insulin 12 days after death. After 12 days, calcitonin and thyroglobulin can no longer be stained, glucagon after 14 days, and insulin after 29 days. The aim of the present study was to test this original data on independent case material. Included in this control study were 105 cases with known time since death (between several hours and 22 days). Pancreatic tissue was stained for insulin and glucagon, and the thyroid gland for thyreoglobulin and calcitonin. The original findings could be generally confirmed, however for calcitonin and thyreoglobulin we observed earlier negative stainings. Altogether immunohistochemistry may still be useful as an additional method for estimating time since death in forensic cases.

Suicide by stabbing while driving a car.

Complex suicides represent only a small number of all suicides. The case of a 27-year-old man who drove his car against a tree is presented. The emergency physician diagnosed a stab to the thorax. A kitchen knife was found on the rear seats of the vehicle. Autopsy revealed death by exsanguination due to perforation of the left cardiac ventricle. Blunt force injuries caused by the collision were also found.

Fatal bleeding from an aortocoronary bypass.

Coronary bypass grafting is a routine procedure in heart surgery, which can now also be performed using a minimally invasive technique on the beating heart. In the presented case, a 55-year-old man died two days after bypass surgery. His condition had deteriorated post-operatively over 2 days until he finally died from multi-organ failure and cardiogenic shock. Autopsy revealed a fatal haemorrhage into the chest cavities from a small tear in the bypass and acute myocardial infarction. The haemorrhage had not been noticed in the hospital. Postoperative haemorrhage is a common complication after this type of surgery, which occurs in about 1-2 % of cases.

Precision of estimating the time since death by vitreous potassium-Comparison of 5 different equations.

The precision of death time estimation by vitreous potassium using 5 different formulas is compared on a random sample of 600 cases. Mean differences, standard deviations and 95% limits of confidence between real and extrapolated time since death were calculated. The best results were obtained using equations with "mean" slopes of about 0,17 or 0,19mmol/l per hour. Equations with a steeper or flatter slope reveal already great mean deviations between real and extrapolated time since death and do not allow a reliable death time estimation.

Forensic aspects of starvation.

Fatal starvation is a rare cause of death in industrialized countries. However, it may have major medicolegal importance if death results from the deliberate withholding of food, especially from infants. In such cases, the task of the forensic pathologist and the medical examiner, respectively, is to clarify the cause of death and give an expert opinion on the degree and duration of starvation. Several classification systems have been developed to estimate protein-energy malnutrition in developing countries. Simpler classifications, such as the Gomez classification, use the weight expected for the respective age group as the standard. However, smaller infants will be lighter, and therefore the classification may not be accurate in this case. Following the Waterlow classification, the extent of stunted growth (referring to growth retardation in cases of chronic malnutrition) is calculated using the ratio of the measured body height to that expected for the age. Using such classification systems, grading of stunting and wasting can be achieved and may greatly help in the assessment of a given child's nutritional status in legal cases. The application of the Waterlow classification to the authors' case material and previously published cases in the literature is herein demonstrated. The Waterlow classification is not only of importance for grading the final stage of fatal starvation, but also for the chronological development of the nutritional status if anthropometrical data have been repeatedly recorded from the affected individual in vivo.

Fatal injuries caused by a bull.

Fatalities caused by cattle occur relatively often in rural areas and mostly show sharp and blunt injuries. In the presented case, a 61-year-old farmer was found dead in a cowshed together with an untied bull. Autopsy revealed severe hemorrhages and massive chest trauma with multiple bilateral rib fractures. The cause of death was severe chest trauma. In the presented case, death was not brought about by the bull's horns but by butts to the man's chest.

Lethal hypothermia after firing a suicidal shot to the head in a car.

In suicide cases involving an automobile, the car is mostly used as a tool/instrument for the suicide (intoxication by exhaust fumes, crash against solid objects such as a pylon). However, a car is uncommonly also used only as the location for a suicide. In the present case, a 70-year-old man had been found dead on the passenger seat of his car. According to witnesses, the car had not been parked there at the same time of the previous day. During that period, the weather had been dry, with temperatures ranging from -1° C at night to +5° C during the day. The man had shot himself with a small-caliber revolver (so-called bulldog-revolver) almost horizontally in the left temple (transtemporal shot through the frontal lobes). Obviously, the suicide had retained the capability to act at least for a short time, as the revolver was found under his left bottom. As morphological signs of prolonged agony some findings of hypothermia were observed (e. g. Wischnewski spots of the stomach).

[Suicidal fall from height after restraint or accident?]. / Suizidaler Sturz aus der Höhe nach Fixierung oder Unfallgeschehen?

Restraining patients is common practice in psychiatric hospitals and is permitted by section 1906 BGB (German Civil Code) if there is a risk of suicide or serious self-damage because of a mental disease or mental disability. Permanent monitoring and supervision during restraints should be obligatory not only in psychiatric hospitals. Nevertheless a number of deaths have occurred during restraints, usually due to strangulation. Reports of cases with suicidal actions after self-release from restraint are rare in the literature. We report on the case of a 45-year-old woman who had suffered from schizophrenia for more than 20 years. After admission to a hospital, she had to be restrained since she became more and more aggressive. When the monitor showed no vital signs any more, nurses checked the patient's room and found an empty bed. The woman was detected lying on the ground in a pool of blood under an open window of the hospital. The cause of death was a polytrauma with leading cranio-cerebral injuries. Obviously the woman had freed herself from the restraining device and committed suicide by jumping out of the window on the third floor.