[Fatal child neglect in West Germany 1 January 1985 to 2 October 1990. Results of a multicenter study]. / Tödliche Kindesvernachlässigung in der Bundesrepublik Deutschland im Zeitraum 1.1.1985 bis 2.10.1990. Ergebnisse einer multizentrischen Studie.

UNLABELLED: Up to now reliable data were available on cases of lethal child neglect in the area of the Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period from 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 19 cases of lethal child neglect. Extrapolated to all institutes of legal medicine, this corresponds to 20 cases and thus 3.5 cases a year in the whole of West Germany in the period studied. There is to be added a dark-field which cannot be limited more precisely. However, the cases of fatal child neglect might have occurred much more seldom than fatal child abuse caused by use of physical violence. Slightly more than half the victims were younger than 1 year, the oldest one was 7 10/12 years old. Most frequently the children died of starvation and thirst. Mostly the mothers/nursing mothers killed the child alone or together with the victim's father/stepfather. In the majority of the cases there was not a close affection between parents and child. Nearly 30% female/male perpetrators suffered from chronic alcohol abuse. Only 15 (= 56%) of 27 female/male perpetrators were sentenced to imprisonment (period between 7 months on probation and 10 years). Mitigation circumstances existed for nearly half the persons sentenced to imprisonment. It is true that child neglect is a rarer crime, but the experts of legal medicine always have to indicate errors made during the external inspection of the corpse (among others failures to see indications of neglect).

[Fatal child abuse (caused by physical violence) in Germany during 1 January 1985 to 2 October 1990. Results of a multicenter study]. / Tödliche Kindesmisshandlung (durch physische Gewalteinwirkung) in der Bundesrepublik Deutschland im Zeitraum 1.1.1985 bis 2.10.1990. Ergebnisse einer multizentrischen Studie.

UNLABELLED: No reliable data are available on cases of lethal child abuse (by active force) in the area of Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 58 cases of lethal child abuse. Extrapolated to all institutes of legal medicine, this corresponds to 62 cases in all of West Germany in the period studied. An approximately equal number of unreported cases should be added to this figure. Including unreported cases, at least 20 cases of lethal child abuse occurred per year; thus only one in every two cases ever came to light. Almost two thirds of the victims were younger than one year old. At autopsy 59% exhibited signs of repeated abuse at autopsy. By far the most common cause of death was direct impact from a blunt object, usually to the head. Mostly, the male person to whom the victim relates most closely (father, stepfather, partner of the mother) has killed the child. Twenty-one of the 74 persons charged saw the charges against them dropped or were acquitted due to lack of evidence; 51 received sentences ranging from one year probation to life. In the remaining two cases the outcome of the trial was unknown. Signs of abuse were readily apparent at autopsy in almost all cases. The high number of unreported cases underscores the need to educate medical students and practicing physicians to be on the look-out for signs of abuse and argues for an increase in the rate of autopsy.

Abnormal radionuclide uptake in pseudomyxoma peritonei.

A case of pseudomyxoma peritonei with increased radionuclide uptake in the abdomen is described. The uptake of the radionuclide was confined to the omentum as confirmed by the CT study of the abdomen and pelvis. The mechanism of uptake and differential diagnosis are discussed.

Imaging of the diabetic foot. Emphasis on nuclear medicine and magnetic resonance imaging.

Diabetes mellitus affects approximately 5% of the population in the United States. In the United States alone, as many as 50,000 amputations are performed each year for vascular insufficiency or osteomyelitis in diabetic patients. In each case, foot disease is multifactorial.

Renal artery embolism. Correlation with scintigraphic and radiographic findings.

The diagnosis of renal artery embolism should be considered in patients with cardiac disease who present with abdominal or flank pain in association with deteriorating renal function. Often the diagnosis is delayed or missed owing to the nonspecific, varied, and protean clinical manifestations. A case is presented of bilateral renal artery emboli, and initial and long-term scintigraphic and radiographic correlations are provided. Renal scintigraphy should be the initial study of choice. In addition, this procedure allows for sequential noninvasive evaluation of renal function.

[Autopsy results and malpractice expert assessment]. / Sektionsergebnis und Kunstfehler-Gutachten.

39 deaths, in which medical malpractice was suspected and forensic autopsy therefore was carried through, were examinated. Among 22 cases with manifest malpractice not sufficient diagnosis, not adequate anamnesis and mistakes related with surgical treatment are dominant. If any deciding factors refer to medical malpractice, a specialists opinion of the respective discipline should be taken together with medicolegal opinion. In such cases it proved to be useful, when medicolegal expert has a coordinating function.

[HIV-1 prevalence in deaths caused by drug overdose in various large cities of West Germany and West Berlin between 1985 and 1988]. / HIV-1-Prävalenz bei Drogentoten in verschiedenen Grossstädten der Bundesrepublik Deutschland und in Westberlin zwischen 1985 und 1988.

The development of the HIV-1-prevalence among drug deaths (n = 753) in several German cities (West Berlin, Frankfurt, Munich, Hamburg, Bremen, Cologne and Stuttgart) from 1985 to 1988 was evaluated; in 1988 43% of 674 deceased drug addicts were examined. The regional prevalence rate was between 15 and 25%; only in Berlin 42% of the drug deaths were HIV-infected (cumulated data of all cities over the 4-year-period: 26%). There was no uniform or steady regional development of HIV-1-prevalence in the different cities. The ratio men/women among drug deaths was 3:1. The HIV-1-prevalence among males was 22%, among females 40%. HIV-infected individuals were 2-3 years older than seronegatives. Predictions concerning the trend of prevalence rates are not possible up to now. Continuous monitoring of the HIV-status of drug deaths seems to be a worthful method to evaluate the spread of this disease among the risk group of intravenous drug addicts.

[Hypoglycemia as a cause of traffic accidents]. / Die Hypoglykämie als Ursache von Verkehrsunfällen.

Hypoglycemia is the most important subsidiary effect of insulin therapy, where traffic medicine is concerned. A study has been made of 8 motor car drivers each dependent on insulin and involved in road accidents. The evidence was issued during the trial. The questions set out to prove if there was a state of hypoglycemia and if the afflicted could have foreseen this condition. In 5 cases the driving conduct before the accidents was evident in cordinatory disturbances, which resulted in sinuous driving. The accidents all happened in every-day traffic conditions, namely counter traffic (3), front-end collision (3) and through disregard of right-of-way at cross-roads (1). A further accident was conditioned by an alcoholic state while parking in a car-park. The disturbances in consciousness conditioned by hypoglycemia occurred without warning. In 3 cases the predictability (in legal terms Actio libera in causa) had to be conceded, because the drivers had set out on their routes despite warning signals or insufficient intake of nourishment beforehand.

[Forensic medicine roentgen studies in gunshot wounds of the skull]. / Rechtsmedizinische Röntgenuntersuchungen bei Schädelschüssen.

14 X-ray examined deaths caused by cranial bullet injuries are described. Three of them are demonstrated. In all cases with bullet injuries X-ray examination should be done prior to the post mortem. With radiographs bullets can be localised quickly. An antero-posterior and a lateral view are necessary. Little parts of the bullet and bone meal particles may be visible in radiographs along the path of the bullet; using normal technique of autopsy those details may not be visible.

[Self-defense injuries in homicides caused by penetrating forces]. / Abwehrverletzungen bei Tötungsdelikten durch scharfe Gewalteinwirkung.

101 homicides caused by stabbing were examined for the presence of defence-injuries. 50 victims showed 174 defence-injuries on hands and forearms (133 incision wounds, 26 stab wounds and 15 cutting through). More than two thirds of lesions were found on left arm. That those lesions mostly were found on left arm is caused by the interaction between perpetrator and victim. Victims left arm is nearest to the perpetrator therefore it is used as a mean of defence first of all. The probability that defence-injuries can be seen is rising with the number of stab wounds. Localisation of a defence-injury on the extensor side ("passive") or on the flexor side ("active") is conditioned by accidentalities. Such a differentiation should be given up because no conclusions on the readiness of defence can be drawn.

[Strangulation marks in homicides caused by choking ? On an irritant blood stain picture]. / Drosselmarken bei Tötungsdelikten durch Erwürgen? Zu einem irritierenden Spurenbild.

Three homicides and one attempted homicide by choking in which apparent signs of throttling were present on the skin of the neck are described. The victims wore slender necklaces which were pressed against the skin by the hands of the perpetrator, causing transverse hematomas and cutaneous abrasions. The following criterious are typical for simulated signs of throttling: similarity to objects on the neck, incomplete course around the neck, absence of coarctation of the soft tissues, no lesions of subcutaneous structures.

[Structure of the hair in thallium poisoning]. / Untersuchungen über die Haarstruktur bei Thalliumvergiftung.

The alterations in the hair roots discovered by Widy in 1956 were interpreted as accumulations of pigment which form as a consequence of a catalytic action of the poison. The goal of the present investigation was to clarify the structure of these inclusions. Hair from the heads of six victims who were involved in the poisoning of Würzburg medical students in January 1983 was available as investigation material. In the investigation in transmitted light and in polarized light, the black zones typical for thallium intoxication were found filling to varying extents the root and hair shaft near the root. Their intensity corresponded to the degree of severity of the intoxication. When examined under reflected light, the inclusions were shown up with a white color. They thus showed the same optical behavior as the air-filled medullary strand of normal hairs. This indicates that gaseous constituents are involved. This hypothesis could be confirmed by further investigations. After mechanical damage to the hair (pressing under high pressure), the gaseous inclusions disappeared and with them the "thallium strip." The same effect was attained by the chemical action of various acids, embedding agents, and dye solutions. This process was especially rapid after exposure to thioglycolic acid; the escape of the gas bubbles can be directly observed here. Scanning electron microscopic investigations on transverse sections of hair revealed a loosening of the spindle-shaped elements of the fiber layer as signs of structural disturbance. The gaseous constituents in thallium hair arise as the result of a trophic disorder in keratin formation. The structural alteration due to this leads to alopecia.

[Death in a tetany attack]. / Tod im tetanischen Anfall.

A case of latent tetany in a 24-year-old woman is reported. She had suffered several attacks of tetany in the last 12 years, mostly triggered by external stimuli. One evening, the woman was found dead in the hall of her flat beside the telephone with the upper limbs in a tetanic convulsive attitude. The attack of tetany was triggered by a telephone conversation. The parathyroid glands were normal. Day-old purulent myocarditis could be demonstrated in the left ventricle under the light microscope. The two possible pathogenetic explanations of the causal chain leading to death are discussed. It was astonishing that a clinical symptom (tetanic convulsion) was fixed in rigor mortis.