The evaluation of doxepin concentrations in postmortem blood as optional cause of death.

The problems concerning an unstable data basis with regard to lethal Doxepin concentrations have been manifested based on a case about a 39-year-old man, who was found dead in his apartment with strangulation marks on his neck, for which a lethal Doxepin intoxication entered the differential diagnosis discussion. For a long time it has been known that postmortem redistribution leads to a falsely inflated concentration as measured in cardiac blood, while the concentrations in peripheral postmortem blood change comparatively little. Despite this, most of the current literature relies on published case report, which fails to mention the location of blood sampling, whereby it is fairly safe to assume that a central sample is intended. Only 9 cases of an isolated lethal Doxepin intoxication have been found, in which the concentrations in blood samples from peripheral vessels had been measured. These values lie between 1.5 and 7.0 mg/L, which is in the lowest quarter of the span of lethal concentrations mentioned in literature without specific mention of the location of the blood sample.

[Lethal intravenous infusion of a wound antiseptic containing polyhexanide]. / Tödliche intravenöse Infusion eines polyhexanidhaltigen Wundantiseptikums.

Polyhexamethylene biguanide (PHMB) is considered to be highly histocompatible and is one of the most frequently used wound antiseptics. Only one case of intoxication has been reported so far. The present case of a lethal intoxication is the first fatal incident described where causality is substantiated by a temporal coincidence between application and ascertainable organ damage. The laboratory-chemical and histological investigations verified the toxicity of this substance after intravenous application with the main findings being severe hepatic and pancreatic damage.

Immunocytochemical examinations of biological traces on expanding bullets (QD-PEP).

When a crime victim has been injured with several different objects, it is of central importance for the forensic investigation to be able to show which object caused which injury, especially if one of the injuries was lethal. In cases of bullet penetration wounds it is often not possible to find such evidence. However, immunocytochemical investigations can accurately match a victim's injury to a particular bullet path through the body. In cases where expanding bullets have been used and the heart or liver has been struck by a projectile, it can be shown that the cells remaining on the bullet stem from those particular organs. In this case the specific cytological evidence was established by means of marking heart- and liver-specific tissue proteins with appropriate antibodies (cardiac troponin I and HepPar 1) followed by disclosure with an appropriate chromogen. Thus, in principle, cells can be used as evidence after being extracted from the projectiles by either damp cotton-wool swabs or adhesive trace evidence tape. Because of the specificity of the used immunocytochemical antibodies, finding evidence of an antigen on a particular projectile proves that it was the object that injured the organs.

[Sudden death in the presence of systemic mastocytosis and urticaria pigmentosa]. / Plötzlicher Tod bei systemischer Mastozytose mit Urticaria pigmentosa.

Systemic mastocytosis is an extremely rare disease characterised by abnormal mast cell production and accumulation of mast cells in the bone marrow or organs, and to some extent also in the skin (urticaria pigmentosa). To date there have been no descriptions of death caused by systemic mastocytosis. The present first description of such a fatality is based upon a case of anaphylactic histamine shock, probably caused by the consumption of peanuts. The affected person suffered from urticaria pigmentosa and developed a fairly typical pruritus prior to death. In the serum sample taken post-mortem the tryptase concentration was markedly elevated. The diagnosis of systemic mastocytosis was established on the basis of two primary and three secondary criteria according to the WHO classification, which underlines the importance of histological investigations in cases where the cause of death is unclear.

[Visualization of biological traces on evidence by ninhydrin]. / Visualisierung von biologischem Spurenmaterial auf Spurenträgern mit Hilfe von Ninhydrin.

Because of possible contamination of samples with PCR inhibitors and to avoid the typing of mixed profiles the source material for forensic DNA investigations should be collected as directly and securely as possible from the evidence. This approach requires a detectability of the source material which is often not given. The procedure introduced here using selected cases enables visualization of DNA-containing materials on evidence and hence controlled analysis. For this purpose the specimen is treated with ninhydrin. A following dye reaction verifies the presence of biological material, which possibly contains DNA. An impact on subsequent STR-analysis was not observed.

[Immunohistochemical proof of amelogenin in teeth--a contribution to the evaluation of the age in the identification of unknown corpses]. / Immunhistochemischer Nachweis von Amelogenin an Zähnen--ein Beitrag zur Abschätzung des Lebensalters bei der Identifikation unbekannter Leichen.

When a corpse is found that cannot be identified, one of the forensic tasks is to determine how old the person was when she or he died. To solve this frequently asked question in forensic practice, the enamel protein amelogenin was marked immunohistochemically in 249 extracted teeth. Amelogenin is already produced during prenatal development and is gradually used up throughout life into old age. Hence, the demonstrability decreases with age. The extent of the labelling can be quantified by measuring the mean optical density (MOD). While it is not possible to determine the age on the basis of the mean optical density measurements alone, logistic regression of the MOD together with dichotomisation of the teeth according to age allows statements as to whether the person was younger or older than 30 years.

Growth/adhesion-regulatory tissue lectin galectin-3: stromal presence but not cytoplasmic/nuclear expression in tumor cells as a negative prognostic factor in breast cancer.

BACKGROUND: The endogenous lectin galectin-3 can regulate cell adhesion and proliferation in vitro, thus prompting the examination of its clinical relevance in breast cancer. MATERIALS AND METHODS: Immunohistochemical processing of tissue sections (n = 273; drop-out rate 20.4%) was used for the assessment of galectin-3 expression. Cytoplasmic/nuclear staining and presence in the tumor stroma were analyzed in human breast cancer patients. RESULTS: A weak correlation with positive steroid receptor status was revealed for cytoplasmic positivity. Nuclear staining was correlated to the lobular type of invasive carcinoma, and tumor stroma expression to high-grade malignancy. Multiple testing of cut-off points to divide the cases into groups based on different levels of immunopositivity combined with univariate Kaplan-Meier survival analysis and computations following the multivariate Cox regression model disclosed no prognostic correlation to either cytoplasmic or nuclear expression of galectin-3. The presence of galectin-3 in the stroma, however, indicated an unfavorable prognosis. Prediction of overall survival was feasible using a model consisting of stage and c-erbB2 status. CONCLUSION: These data signify that caution should be exercised in extrapolating from the anti-apoptotic/prometastatic activity of galectin-3 in model systems to the clinical situation.

[Dynamics of decapitation after falling in a self-tightening rope noose]. / Dekapitationsdynamik nach Sturz in eine sich unter Last selbst verengende Seilschlinge.

In decapitation by dropping into a slip noose, it is in principle justified to doubt that suicide is involved. It must hence always be checked whether the dynamics to be inferred from the concrete facts can result in decapitation. Essential characteristics of the dynamics are the deceleration forces (tractional force of the rope) that are determined by the height of the drop, the directional force of the rope and the body mass of the victim as well as the density of the lines of centripetal force acting on the neck. However, the appropriateness of the dynamics must at all events be corroborated by compatible autopsy and scientific criminological findings with regard to the characteristic wound morphology, the intravital signs, the trace analysis and the topography of the fiber ablation traces on the rope that are due to the effect of heat.

Detection of colchicine by means of LC-MS/MS after mistaking meadow saffron for bear's garlic.

The accidental ingestion of plant material containing colchicines is a rare cause of lethal poisoning. The death of a married couple who mistook colchicines for Bear's garlic (Allium ursinum) and prepared the latter as a salad is the tragic topic of this article. After discussing the specificity of the histological findings, a chemicotoxicological method using liquid chromatographic mass spectrometric (LC-MS/MS) is presented. Toxicological analyses using LC-MS/MS revealed colchicine concentrations between 36.6 ng/mL and 98.3 ng/mL in the heart blood and between 22.7 ng/mL and 78.4 ng/mL in the femoral blood of the victims.

Two-tailed delimitation of the time of death by immunohistochemical detection of somatostatin and GFAP.

Delimitating the time of death becomes increasingly difficult and inaccurate, the further back it lays in time. To contribute to available techniques, pancreas and brain tissue from 500 corpses, whose time of death lay within 1 day and 23 days ±1 day, were immunohistochemically stained with anti-somatostatin and anti-glial fibrillary acidic protein (GFAP) antibodies. Somatostatin and GFAP are recognized as antigen by the employed antibodies. This does not occur when proteolytic processes after death disturb the tertiary structure, altering its antigen properties. In our cases, stainability of somatostatin in the pancreas was always given within 2 days after death. Hence, given a negative immunoreaction, death can be assumed to have occurred a minimum of 3 days before formaldehyde fixation, which stops the proteolysis. A negative immunoreaction occurred consistently after 11 days, indicating that if a positive reaction is obtained in a specimen, the death of the respective person must have occurred amaximum of 10 days before fixation. GFAP was always stainable in the frontal cortex within 3 days after death, which means that in the case of a negative immunoreaction, death can be assumed to have occurred a minimum of 4 days before fixation. A negative immunoreaction occurred consistently after 14 days, indicating that if a positive reaction is obtained in a specimen the death of the respective person must have occurred a maximum of 13 days before fixation. The presented methods provide further improvements of the possibilities of delimitating the time of death, whereby the combination of both methods allows a two-tailed delimitation.

[Quantification of human DNA from forensic samples via real time PCR by the help of a telomerase assay]. / Quantifizierung humaner DNA aus forensischen Proben mittels Real-time PCR unter Verwendung eines Telomerase-Assays.

Quantitative data concerning the content of human DNA and the effect of PCR inhibitors in a sample would provide very important information within a forensic DNA analysis. With the help of real-time PCR it is possible to test DNA samples for these influencing factors. However, the amplified DNA segments detected by means of usual TaqMan DNA probes are longer than most of the short tandem repeats to be investigated. Because of possible DNA degradation, a DNA probe located in the human telomerase transcriptase gene was successfully tested on forensic samples in the present study. Its amplified DNA segment is only 94 bases in length and, thus, shorter than the short tandem repeats. Therefore, it seems perfectly suited for the examination of degraded DNA. With the telomerase probe it was possible to obtain accurate results of the influence factors mentioned above. Based on the findings of this examination and on a case example, in which the poorly preserved remains of a baby were subjected to paternity testing, the possible uses of the telomerase assay are discussed.

Evidence of multiple hepatitis virus infections in autopsied materials of intravenous drug addicts.

Injection of illicit drugs is an important risk factor for acquiring parenterally transmitted viral infections. To investigate the prevalence of viral mono- and co-infections in intravenous drug uses (IDUs) postmortem and to evaluate the risk of potential infection to personnel involved in medicolegal practice a total number of 59 known IDUs were tested during necropsy for serological markers of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) as well as for the nucleic acids of the hepatitis B and C viruses, and the GB virus C (GBV-C), in blood and in the liver. Our findings showed that 90.2% cases were positive for at least one or more serological markers of the tested viruses. Seroprevalence rates of anti-HCV, HBsAg and anti-HIV were 78.4%, 32.4% and 29.7% respectively. Of the IDUs tested for serological infection markers 43.2% were positive for one, 40.5% for two and 5.4% for all three markers. Viral nucleic acids were detected in the sera of 64.4% and in the liver of 81.4% of the cases. HCV, RNA, GBV-C RNA and HBV DNA were found in 33.9%, 28.8% amd 28.8% of the serum samples and in 67.8%, 35.6% and 28.8% of the liver tissue, respectively. Active viral co-infections or triple infections were detectable in the sera of 20.3% and in the liver of 39% of the case. Results show that the sensitivity of viral nucleic acid testing postmortem strongly depends on the quality and source of material used.

[Fatal head trauma of an infant. Part II: Biomechanical reconstruction]. / Tödliches Schädel-Hirn-Trauma bei einem Kleinkind. Teil II: Biomechanische Rekonstruktion.

An 18-month-old child was hit on the head by a falling wooden sculpture (c 60 kg) and sustained a fatal craniocerebral trauma. The kinetics of the trauma could be accurately reconstructed. The child's skull was then modelled using the finite-element-method. The material parameters known from the literature were assigned to the elements. The dynamic reconstruction performed on the basis of the kinetics calculated before was able to reproduce the destruction of the skull and the brain by simulating the impact-related topographical distribution of the intracranial pressure and the von Mises stress field.

[An already archived latent fingerprint as a DNA source for STR typing in a murder case]. / Eine bereits archivierte Fingerspur als Ausgangsmaterial für eine STR-Analyse in einem Mordfall.

Former studies have shown that even a single skin contact, resulting in a latent fingerprint, can transfer enough DNA for genetic analysis. However, up to now latent fingerprints have usually not been used for DNA typing. In the present case the smeared trace of a hand was found in the suspect's car and archived. As it could not be evaluated in a classical manner, the evidence had to be examined by molecular genetic methods. DNA was extracted and typed in five different STR loci. Based on the yielded results, the significance of the findings is discussed.

Asphyxia due to pacifiers--case report and review of the literature.

Pacifiers and bottle nipples entail the risk of asphyxia when they are swallowed, self-made or have become porous, or when used by older children whose teeth and chewing musculature have developed beyond the suckling stage. A further danger lies in the various devices used to tie the pacifier to the child, as they can cause strangulation. On the basis of this first case of a 2-year-old biting off a piece of her pacifier and fatally aspirating it, we point to the dangers and security requirements related to pacifiers and bottle nipples, and give a review of the related literature.

[Reconstruction of a real car-pedestrian-accident. Part I: Generating an individual digital topographic image of the victim]. / Rekonstruktion eines realen PKW-Fussgänger-Unfalls. Teil I: Erstellung der individuellen digitalen Oberfläche eines Unfallopfers.

The aim of forensic biomechanics is the reconstruction of traumatic events based on the pathological findings in the victim's morphology, the accident traces and the car damages. The use of forensic documentation tools (e.g. Streifenlichttopometrie) enables 3-dimensional and proportional accurate documentation of the victim's body, of its injuries and of the car damages with submillimeter precision. The generated topographic image serves as input for a multi-body system model of the victim. It allows further to determine exactly the contact points between car and victim for a computer simulated dynamical reconstruction of the impact situation. In the case of an accident involving a car and a pedestrian the generation and application of computer aided 3-dimensional reconstruction models are shown.

First-pass metabolism of ethanol in human beings: effect of intravenous infusion of fructose.

Intravenous infusion of fructose has been shown to enhance reduced form of nicotinamide adenine dinucleotide reoxidation and, thereby, to enhance the metabolism of ethanol. In the current study, the effect of fructose infusion on first-pass metabolism of ethanol was studied in human volunteers. A significantly higher first-pass metabolism of ethanol was obtained after administration of fructose in comparison with findings for control experiments with an equimolar dose of glucose. Because fructose is metabolized predominantly in the liver and can be presumed to have virtually no effects in the stomach, results of the current study support the assumption that only a negligible part of first-pass metabolism of ethanol occurs in the stomach.

[Fatal craniocerebral trauma in a young child. I: Forensic documentation, model generation and geometric impact conditions]. / Tödliches Schädelhirntrauma bei einem Kleinkind. Teil I: Forensische Dokumentation, Modellgenerierung und geometrische Impactbedingungen.

The aim of forensic biomechanics is the reconstruction of traumatic events based on the pathological findings in the victim's morphology and on the traces and shapes of the traumatizing tools. The introduction of Streifenlichttopometrie into forensic science enables 3-dimensional and proportionally accurate documentation of the victim's body and injuring agent with submillimeter precision. The advantages of this method of documentation are the possibilities of producing animated models which correspond exactly to the body's shape and injury topography, and of ascertaining the physical parameters (centers of mass, moments of inertia) of the various body parts and the geometrical impact conditions for the reconstruction of the injury dynamics. This way of proceeding thus enables more precise models than hitherto possible for kinetic and dynamic reconstruction. In the case of an infant who was fatally injured by a wooden sculpture the generation and application of computer aided 3-dimensional reconstruction models are shown.

[Fatal inhalation of butane-propane gas]. / Tödliche Inhalation von Butan-Propan-Gas.

Fatal intoxications with butane and/or propane are rare although the inhalation of such liquid gases in order to induce hallucinations is not uncommon amongst youngsters, the number of which is difficult to evaluate. Thus the possibility of gas intoxication should be taken into consideration in all cases of unclear death of youngsters, in which case the macroscopic and histological findings will be unspecific whereas the chemical-toxicological analyses, especially of the native brain, lung and liver tissue, lead to definite conclusions.

Computer aided shot reconstructions by means of individualized animated three-dimensional victim models.

In cases of lethal firearm injuries with indefinite indications concerning self-versus third-party infliction a computer enhanced reconstruction with the aim of an anatomical feasibility study can provide significant clues concerning the course of the traumatic event. To this end an exact three-dimensional geometrical model of the victim including all relevant anatomical data as well as the careful documentation of the injuries and a three-dimensional model of the characteristic outlines of the weapon true to scale is generated with the help of an animation program (POSER Version 4, Meta Creation, Egisys AG). With this animated digital three-dimensional model of the victim and the weapon a series of simulation sequences is created by variation of the body positions and the grasp of the weapon. Anatomically impossible positions in view of the physical characteristics of the victim and the site and direction of the bullet path are automatically excluded from the reconstruction. An exact match of the simulation sequence and the real injuries is a statement for a possible self-infliction of the gunshot wound.