Iatrogenic ruptures of the stomach after balloon tamponade. Two case reports: viscoelastic model.

Two cases of gastric rupture as a rare complication of balloon tamponade for esophageal varices are presented. In both cases, the rupture was caused by instillation of irrigation fluid without previous aspiration of stomach contents. In an experimental study, the stomachs of 11 corpses were filled with water to determine rupture pressure and volume. The mean rupture pressure was 73 +/- 13 mm Hg (9.7 +/- 1.7 kPa) and the mean rupture volume was 2,670 +/- 410 ml. A viscoelastic model was used for the representation of the relations between pressure and volume as well as pressure and time. Measured values are significant particularly for the explanation and medicolegal evaluation of iatrogenic ruptures of the stomach that occur during gastric lavage, positive pressure respiration, incorrect intubation, or forced mask respiration during resuscitation.

[Contact neck gunshot wound without weapon--suicide or homicide?]. / Aufgesetzter Nackenschuss ohne Tatwaffe--Suizid oder Homizid?

To support police in reenacting criminal acts is one of the most important functions of forensic investigation. This case report deals with the discovery of the corpse of a 42-year old man at the bank of the river Inn. First of all the man was supposed to be drowned, but the autopsy showed a gunshot wound of the neck and a shot-through of the brain-stem. Intensive search for the weapon by the police and by divers was unsuccessful and therefore suspicion of homicide arose. The reconstruction of the act at the site of discovery of the corpse led to the discovery of the weapon and the case became clear to be a suicide.

[Epidemiology of fatalities in Alpine skiing--(1987-1990)]. / Epidemiologie von Todesfällen beim alpinen Schisport--(1987-1990).

At the Institute of Forensic Medicine, University Innsbruck, 78 cases of fatal accidents and of sudden death were examined which occurred during alpine skiing between 1987 und 1990. An increase of fatal accidents during skiing was observed in the past few years. This fact is related to the rising utilization of summer skiing areas. In about three quarters of the cases death as consequence of an accident was observed. One quarter died a sudden death. In this group myocardial infarction is dominant, which is an indication of an enhanced load of the cardiovascular system during skiing in higher altitudes. In the group with fatal accidents cranio-cerebral traumas including medulla injuries are dominant.

[Forensic medicine aspects of death caused by hypothermia in high altitude]. / Gerichtsmedizinische Aspekte des Unterkühlungstodes in höheren Lagen.

Macro- and micromorphological findings in cases of death from hypothermia are very questionable and unreliable diagnostical signs. We investigated 42 cases of death from hypothermia that occurred in mountain-ranges between 1974 and 1990. All cases showed erosions of the gastric mucosa ("Wischnewsky-spots"), in one case only we found bleedings in the ileopsoas muscles. In most cases hypothermia was based on natural disease or intoxication. Nine alcoholized persons showed a mean alcohol concentration in the blood of 1.07% and in accordance to a relatively long agonal period the alcohol concentration in urine was considerably higher.

[Discovery of human bones at the Prägratkees (Tyrol) 1953 and 1990]. / Zur Ausaperung menschlicher Knochen am Prägratkees (Tirol) in den Jahren 1953 und 1990.

At the Prägratkees (Granatspitz, Tyrol) human bones, pieces of equipment and garment were found at the same site in 1953 and 1990. According to the forensic investigations, the bones were attached to a 37 year-old mountain climber, who has been missed since 1936. Because of the fact that between both discoveries an interval of 37 years elapsed, it is doubtful whether the bones are from one person. The forensic conclusion, that the bones are attached to one person could be supported by the glaciological situation of this glacier.

Fatal accidents on glaciers: forensic, criminological, and glaciological conclusions.

The rare event of a corpse immersed in glacier ice becoming exposed on a glacier surface is closely connected with the glaciological conditions at the scene and the site of the accident. Provided that the time since death is known, certain questions relative to the circumstances of a mountain accident can only be answered by considering glaciological aspects. How the scene of an accident can be reconstructed by inference from the site of discovery is discussed by means of three exemplary cases that occurred on Tyrolean glaciers (Austria) during the past 40 years: (1) Two corpses were discovered close above the equilibrium line in the accumulation area after 25 years. The two victims had fallen down a rock face after the breaking off of a cornice and had come to rest in the uppermost part of the accumulation area. (2) A victim was discovered in the lower ablation area 8 years after falling down a crevasse in the middle part of the ablation area. (3) A female alpinist was discovered at the very end of the glacier after 29 years; it was concluded that the accident must have happened in the accumulation area.

Postmortem evaluation of serum and urine neopterin concentrations.

Cellular immune response is accompanied by the release of neopterin. Increased neopterin levels in urine and serum are observed in patients during viral infections, autoimmune diseases, and allograft rejections and certain malignant diseases. We investigated postmortem neopterin concentrations in urine and serum samples taken from 32 corpses 3 to 69 h (mean 19.3 h) after death. Urine neopterin concentrations in corpses are similar to those of healthy live controls and are independent of the time after death. In contrast, serum neopterin concentrations are frequently greatly increased in corpses, and the levels are higher in sera collected more than 10 h after death in comparison with samples obtained earlier. Neopterin measurement in urine and serum samples of corpses is feasible. It appears likely that urine neopterin concentrations could aid the diagnosis of inflammatory diseases in corpses.

[Asphyxia protracted after shaking trauma]. / Protrahierte Asphyxie nach "Schütteltrauma".

A case of "shaken baby syndrome" (SBS) is reported. A 3 1/2 months old female baby has been found by his mother death in bed. The circumstances predicted a case of Sudden Infant Death Syndrome (SIDS), but the father, a disc-jockey, who had to look for the baby, had left a notice: "Gitti--i didn't want it, I don't know what had happened, I'm sorry!". The corpse of the baby had no external signs of violence. At the medicolegal examination we found small subarachnoidal and subdural hemorrhage from ruptured bridge veins and signs of prolonged asphyxia. Few hours later the father could be arrested. He told that he had shaken the baby, because she didn't stop crying. The infant lost conscious and he layed him down to the bed with his face below. Then he looked TV for at least a few minutes. After insufficient reanimation he had left the house. The court found the man to be guilty of fatal infant child abuse and convicted him to detention of 8 months. The main signs of SBS are discussed (subarachnoidal and subdural hemorrhage, intraretinal and periretinal hemorrhages, brain edema). Especially in the german speaking Europe many medical examiners are not familiar with this form of infant child abuse.

[Unusual wound morphology after textile penetration by the automatic rifle (StG) 58. A case report]. / Ungewöhnliche Wundmorphologie nach Textildurchschüssen mit dem Sturmgewehr (StG) 58. Ein kasuistischer Beitrag.

Technical characteristics of the used fire-arm and ammunition, the firing range and the shot through garments of the victim are essential factors, that exercise an influence on the appearance of gunshot injuries. An exemplary case-report shall emphasize the importance of these factors. It deals with a suicidal double-shot fired from an automatic rifle by a young soldier. The wounds were localized in the left chest region and the adjacent skin was blackened by soot in a remarkable geometrical pattern, although an ammunition with a smokeless charge has been used. By means of comparative shots we have good reasons to suppose this phenomenon to be caused by rests of gun powder and pressure of the explosion gas leaved in the barrel after the first shot. The second projectile pushed out this explosion gas to the skin that had been uncovered in a star-shaped way by the first shot.

[Unusual discovery of 2 cadavers in a glacier--forensic and glacier-related aspects]. / Ungewöhnliche Auffindung zweier Leichen im Gletscher--Forensische und glaziologische Aspekte.

Unusual discovery of two corpses embedded in glacier ice in relation to glacier movement is discussed. As a matter of fact in such cases the scene of accident and the place of discovery after a long postmortem time is not the same. Knowing the time after death and the place of discovery it may be possible to ascertain the scene of accident and to draw conclusions on the proceedings of accident.

[Postmortem changes after 50 years immersion (1939 reconstructed suicide)]. / Leichenveränderungen nach 50 Jahren Wasserzeit (Erweiterter Suizid im Jahre 1939).

In September 1989 an old motor car was accidentally discovered in a lake, 50 meters below the water surface. The automobile contained the torso of an adult woman with extensive adipocere formation and the skeletonized body of a man. Forensic and criminalistic investigations lead to the identification of the deceased persons. In the year 1939 the persons together had committed suicide. The corpses were immersed for fifty years.

Postmortem neopterin concentrations: comparison of diagnoses with and without cellular immunological background.

Increased neopterin levels in urine and serum of living humans indicate an activation of the cellular immune system. We investigated 119 urine and 48 serum samples from 129 corpses taken at necropsy; 29 cases with a background of cellular immune activation were compared to 100 corpses with no such indication. Our investigations show the feasibility of postmortem neopterin measurements. However, different kinetics of serum and urine concentrations after death were observed. In addition, the data show that urine and serum neopterin concentrations were significantly higher when cellular immunological abnormalities were present when compared to the control group and to living healthy controls. The findings suggest, that increased postmortem urine neopterin concentrations in necropsy indicate pathological processes linked with cellular immune activation.

[Fatal injuries caused by glass fragments. Case reports and autopsy findings]. / Tödliche Verletzungen durch Glasfragmente. Falldarstellungen und Sektionsbefunde.

The authors report three cases of fatal domestic accidents by falling through glass doors. Multiple cuts and stabwounds in one of these cases primarily suggested a crime of violence. In contrast the bodies of the two other perished persons showed only unsignificant injuries. Causes of death were aerous embolism (1 case) and mechanical bleeding to death (2 cases). The common morphological signs of these glass injuries are exemplified and preventive measures are discussed.

Unusual finding in a water-logged corpse--hyperchylomicronemia or pulmonary fat embolism?

During excavation work at the bank of the River Inn the corpse of a 32-year-old alcoholic male was recovered. Head injuries suggested a crime of violence. Postmortem examination demonstrated conspicuous milky turbidity of the blood, which was found by laboratory testing to be due to hyperchylomicronemia. The findings are interpreted and their relevance to the determination of postmortal head injuries is discussed. The inadequacy of double-edged knife specimens and frozen-section biopsies for the estimation of pulmonary fat embolism as a vital reaction is considered.

[Fatalities in west Austrian prisons]. / Todesfälle in westösterreichischen Haftanstalten.

The purpose of this study is to review 23 causes of death that have occurred in Western-Austrian prisons from 1974 to 1989. The majority of them (11 cases) were due to suicides. Among 9 cases of natural death there was a 25 years old man, who died of an unknown purulent meningoencephalitis. Two drunken prisoners had not been supervised and therefore died of alcohol poisoning. In one case the police jail physician did not recognize an epidural hematoma.