[Intraocular metastases]. / Intraokulare Metastasen.

Metastatic cancer represents the most common form of intraocular malignancy. Due to its abundant vascular supply the choroid is the most common ocular site for intraocular metastatic disease (approximately 90%). Less than 10% of intraocular metastases are located in the iris and/or ciliary body, whereas the retina and vitreous are rarely affected. Most intraocular metastases are carcinomas; the majority of metastases originate from breast cancer in females and lung cancer in males. However, virtually every primary malignancy has been described to metastasize to intraocular structures. In this review we address the pathology and clinical features of intraocular metastases, noninvasive and invasive diagnostic procedures, as well as the pathological work-up of cytological and histological specimens obtained either by fine needle aspiration biopsy or special biopsy forceps.

[Retinoblastoma and retinocytoma (retinoma)]. / Retinoblastom und Retinozytom (Retinom).

Retinoblastomas are extremely rare withabout half of the cases being hereditary eye neoplasms in young children. They show highly proliferative, CRX-positive undifferentiated tumour cells (occasionally forming rosettes). Staging is performed according to the pTNM classification and the International Retinoblastoma Staging System (IRSS). The diagnostic basis for systemic administration of chemotherapy and/or radiation is postlaminar optic nerve invasion, massive choroidal tumour infiltration, scleral invasion or even extraocular invasion. In cases that are difficult to diagnose, immunohistochemical stains (CRX and Ki67) may be very helpful. Retinocytomas (retinomas) completely lack undifferentiated tumour cell areas, show an exclusive photoreceptor differentiation and an exceptionally low Ki67 index.

Results of hair analyses for drugs of abuse and comparison with self-reports and urine tests.

Urine as well as head and pubic hair samples from drug abusers were analysed for opiates, cocaine and its metabolites, amphetamines, methadone and cannabinoids. Urine immunoassay results and the results of hair tests by means of gas chromatography-mass spectrometry were compared to the self-reported data of the patients in an interview protocol. With regard to the study group, opiate abuse was claimed from the majority in self-reports (89%), followed by cannabinoids (55%), cocaine (38%), and methadone (32%). Except for opiates the comparison between self-reported drug use and urinalysis at admission showed a low correlation. In contrast to urinalysis, hair tests revealed consumption in more cases. There was also a good agreement between self-reports of patients taking part in an official methadone maintenance program and urine test results concerning methadone. However, hair test results demonstrated that methadone abuse in general was under-reported by people who did not participate in a substitution program. Comparing self-reports and the results of hair analyses drug use was dramatically under-reported, especially cocaine. Cocaine hair tests appeared to be highly sensitive and specific in identifying past cocaine use even in settings of negative urine tests. In contrast to cocaine, hair lacks sensitivity as a detection agent for cannabinoids and a proof of cannabis use by means of hair analysis should include the sensitive detection of the metabolite THC carboxylic acid in the lower picogram range.

[Causes of death in nursing homes--a retrospective autopsy study]. / Todesursachenspektrum im Altenheim im Spiegel eines rechtsmedizinischen Sektionsgutes.

Autopsies from 34 fatalities in nursing homes covering a 10-year period (1991-2000) were retrospectively analyzed with regard to criminal investigative issues, causes of death and relevance of the forensic medical findings for the outcome of the criminal investigations. The material consisted of 22 females and 12 males, with the ages ranging from 62 to 102. The allegations to be investigated comprised wrongful death, improper nursing, medical maltreatment, suspicion of poisoning and the causal relationship between falls and the occurrence of death. The manner of death, respectively cause of death encountered included 21 deaths from natural cause (coronary insufficiency, pneumonia), 9 accidental deaths (hypothermia, choking, scalding burns and injuries due to fall) and 4 cases which remained undetermined. In 30 out of 34 cases, the cause of death was unequivocally established. In every case, the medicolegal investigation provided adequate evidence for the legal assessment. Of particular significance was the exclusion of a causal relationship between falls and the occurrence of death. Without exception, all investigations failed to uncover criminal causes for death in this sample.

Injuries in fatal cases of falls downstairs.

Downstairs falls frequently occur within domestic environments and are mainly associated with elderly and intoxicated individuals, often feature multiple injuries on various parts of the body. In most cases it is not possible to determine the cause of the fall and/or death solely by means of external examination. In this retrospective study, which covers a period of 11 years, all cases of death which included a fall downstairs in their case history, were collected from the Forensic Institutes of the Universities of Bonn and Greifswald, Germany. Falls downstairs made up to 2% (166 cases) of all postmortem examinations carried out within this period. Interestingly, almost double of the amount of such falls applied to males as to females. The primary cause of death was cranio-cerebral trauma and the vast majority of skull injuries associated with falls downstairs were found above 'the hat brim line'. Injuries were also often found on several other parts of the body at once. Nineteen of the 116 examined individuals exhibited agonal injuries. In these cases, postmortem examination revealed pre-existing disease or intoxication to be the cause of death and thus, cause of the fall. The injury pattern only allows a tendency towards vital or agonal incident as a conclusion.

[Site of injuries in falls on staircases]. / Zur Lokalisation von Verletzungen bei Treppenstürzen.

52 autopsy cases in combination with falls on staircases examined in the Bonn Institute of Legal Medicine in 1992 to 2000 were evaluated with respect to the query whether the morphological criteria were valid for reconstruction of the fall, in what way facial injuries were involved and whether isolated trunk injuries caused the death. In 80 per cent of all cases the localization of impact on skull and trunk could be deliminated in regards to heaviness of injuries with fractures and involvement of inner organs. Facial injuries were noticed in 50 per cent and were--as well as arm and leg injuries--caused by strike in fall or after impact. In only two cases in consequence of falls on staircases trauma of the trunk led to death by bleeding.

Fatal myeloencephalopathy due to accidental intrathecal vincristin administration: a report of two cases.

We report on two fatal cases of accidental intrathecal vincristine instillation in a 5-year old girl with recurrent acute lymphoblastic leucemia and a 57-year old man with lymphoblastic lymphoma. The girl died seven days, the man four weeks after intrathecal injection of vincristine. Clinically, the onset was characterized by the signs of opistothonus, sensory and motor dysfunction and ascending paralysis. Histological and immunohistochemical investigations (HE-LFB, CD-68, Neurofilament) revealed degeneration of myelin and axons as well as pseudocystic transformation in areas exposed to vincristine, accompanied by secondary changes with numerous prominent macrophages. The clinical course and histopathological results of the two cases are presented. A review of all reported cases in the literature is given. A better controlled regimen for administering vincristine and intrathecal chemotherapy is recommended.

[Simulation of homicide to hide child's suicide]. / Vortäuschung eines Tötungsdeliktes zur Verdeckung eines Kindersuizids.

A case of pretending a homicide to conceal a child suicide is reported in which characteristic findings of the postmortem examination and conclusions from the analysis of forensic autopsy series provided substantial support for the police investigation. In the late night hours of a spring day the police authorities were informed that a 10-year-old girl had been found dead on a playground near its parents' house. As injuries of the neck were recognized by the police officers a homicide investigation was initiated. The post mortem examination showed a furrow symmetrically slanting from the front to the nape of the neck, discrete punctate haemorrhages of the skin of the face and numerous 'tram-line' bruises of the back, buttocks and extremities. These findings indicated as cause and manner of death suicidal hanging following corporal punishment. Confronted with these conclusions the mother immediately made a corresponding confession.

[Forensically relevant unexpected delivery after unrecognized or denied pregnancy]. / Die forensisch relevante Uberraschungsgeburt nach nicht erkannter bzw. verdrängter Schwangerschaft.

The authors report on two cases of supposed unknown pregnancy, in which the newborns were found dead in the lavatory by the emergency physician. Besides the classical questions of newborn's autopsies concerning vitality, viability and cause of death, position was to be stated towards the probability of an unexpected birth. In the first case the mother's statement of not having been aware of her pregnancy was plausible considering the general circumstances such as corpulence, continued bleedings and intact family situation; autopsy proved a (rare) twin stillbirth as a result of fetal hypoxaemia caused by grave placental dysfunction and misinsertion of the umbilical cord. Contrary to this, in the second case, a live birth, a denial of pregnancy was more likely to be assumed due to misinterpretation of typical symptoms of pregnancy in combination with professional and private stress.

[Forensic medicine experiences in cremation autopsy in Bonn]. / Rechtsmedizinische Erfahrungen bei der Kremationsleichenschau in Bonn.

2016 coroner's crematorial inquests of the Bonn Institute of Legal Medicine over a 3 years' period were evaluated and the statements in the death certificates were compared to those ones of the Statistical Country Office of Northrhine-Westphalia. No significant differences were found with respect to age, gender and reason of death. However, the number of insufficiently classified deaths with respect to the reason of death were overrepresented especially in cases of older women, while the number of unnatural deaths was generally underrepresented. According to legal medical criteria 2 1/4 per cent of the deaths were falsely classified as natural. Only in 2 cases an autopsy was accomplished. Other author's statements on the validity of death certificates were confirmed.

[Cadaver dismemberment by chain saw]. / Leichenzerstückelung durch Kettensäge.

It is reported about the dismembering of a 57-years-old man by means of a chain saw, allegedly without participation in the very assault. The victim died after heavy violence to this throat and bleeding from stab wounds. Afterwards his trunk was divided horizontally, his thorax, skull and upper arm were sewn into without cutting through. The closer circumstances of the crime and localization of the saw injuries lead to the assumption of a participation in the assault. Technical details of chain saws and typical findings as to injuries are described.

[Differentiation between self-inflicted and homicidal stab wounds to the neck]. / Zur Differenzierung zwischen Selbst- und Fremdbeibringung von Halsschnittverletzungen.

39 autopsy cases with throat incision examined in the Bonn Institute of Legal Medicine in the years 1990 through 1998 were evaluated with respect to the query whether the morphological criteria generally established for the differentiation between homicide and suicide are also suitable for the assessment in this special localization. Integrative consideration of localization, direction of incision, hesitative resp. tentative injuries, defence injuries, concomitant injuries and capability to act allowed for a discrimination on grounds of legal medical findings in 84 per cent of the cases.