[A retrospective mortality analysis of natural deaths of the 65+ generation based on postmortem autopsies performed at the Institute of Legal Medicine in Frankfurt am Main during two periods]. / Retrospektive Mortalitätsstudie natürlicher Todesfälle der Generation 65+ im Obduktionsgut der Rechtsmedizin Frankfurt am Main anhand zweier Zeitintervalle.

BACKGROUND AND AIM OF THE STUDY: In Germany, a constant demographic change is taking place, which leads to an increasing aging of the society. The present study aimed to analyze natural deaths occurring at an age of ≥ 65 years, since health vulnerability in this age group is gaining importance. MATERIAL AND METHODS: Autopsy reports of the Institute of Forensic Medicine, University Hospital of the Goethe University Frankfurt/Main, Germany, were retrospectively evaluated regarding natural death cases of ≥ 65-year-olds in a time comparison (period I: 2000-2002; period II: 2013-2015). RESULTS: During both periods, a total of 1206 autopsies concerning this age group were performed. Among these, 404 cases (33.5%) of unnatural death and 39 cases (3.2%) of a combination of natural and unnatural death were recorded; in 94 cases (7.8%), the manner of death could not be elucidated. The majority (n = 669; 55.5%) included cases of natural death. In the largest group of these (n = 350; 52.3%), cardiac causes of death were predominant, followed by 132 (19.7%) respiratory and 47 (7.0%) abdominal causes of death. In addition, 37 (5.5%) cases of malignant neoplasms, 33 (4.9%) of ruptures of large vessels, 33 (4.9%) of cerebral, and 37 (5.5%) other cases of natural death were noted. A significant decrease of cardiac causes of death was observed in the comparison of periods I and II. In particular, there was a significant decrease in high-grade occlusive coronary sclerosis. Moreover, there were significant differences between both sexes. Men had significantly more bypasses, stents and heart scars and suffered a myocardial infarction about 10 years earlier than women. CONCLUSION: The results of the present study are largely consistent with the literature. The decrease in numbers of cardiac deaths may be attributed to increasingly better medical care and to a significantly higher rate of stent implantation. Especially in times of pandemics, the role of forensic gerontology will become more important.

Religious denomination influencing attitudes towards brain death, organ transplantation and autopsy-a survey among people of different religions.

BACKGROUND: (Brain) death, willingness of organ donation and autopsy are relevant questions of life and death. Religious beliefs are expected to have a significant influence on individual attitudes. METHODS: People with an active relationship to a religion were surveyed about brain death, organ transplantation and autopsy using an anonymous questionnaire. The study was aimed in particular at students of theology and people in religious communities. In addition to a descriptive statistical analysis, a binary logistic regression analysis was carried out. RESULTS: From November 2016 to April 2017, 1306 people took part in the study. Religious denomination had statistically significant implications. Members of a certain religion were found to share similar positions. Significant differences were noted in the attitudes shown by members of different religions and by those without any religious affiliation. Especially the concept of brain death was rejected by Buddhists. The majority of Sunni Muslims, Hindus and Buddhists rejected organ donation following brain death. In all religious groups, the majority did not possess an organ donor card. Catholics and Protestants had more organ donor cards than any other religious group and more likely supported autopsies. CONCLUSION: Religious denomination plays a central role in the various viewpoints and attitudes. The findings are just as relevant in scientific and public discussions as they are in medical practice and may contribute to increasing sensitivity and professionalism and to facilitate communication.

Renaissance of criticism on the concept of brain death--the role of legal medicine in the context of the interdisciplinary discussion.

BACKGROUND: In the practice of legal medicine in Germany, the assessment of brain death is of minor importance and attracts little attention. However, since several years, international criticism on the concept of brain death has culminated. By reviewing literature and the results of a questionnaire distributed among the participants of the 93rd Annual Congress of the Germany Society of Legal Medicine, the state of knowledge and the current views on brain death were evaluated. MATERIALS AND METHODS: Literature search of recent publications regarding brain death was performed (PubMed database, references of legal medicine, Report of the President's Council on Bioethics, USA 2008). A questionnaire was developed and distributed among the participants of the Congress. RESULTS: The assumption that individual and brain death are synonymous is criticized. Internationally, there are trends to harmonize the very different clinical criteria to assess brain death. The diagnostic advantage of novel techniques such as CT angiography is controversially discussed. It becomes apparent that procedures which record the blood flow and perfusion of the brain will be applied more in the future. Regrettably, these developments are not described in the literature of legal medicine. Moreover, among German forensic scientists, different views concerning brain death exist. The majority favors its equivalent treatment with individual death. The thanatological background can be improved concerning certain aspects of brain death as well as its legal implications. CONCLUSION: Teaching and research in legal medicine should include the subject brain death. Expertise in forensic science may contribute to the interdisciplinary discussion on brain death. The transfer of actual knowledge, also on disputed ethical aspects of thanatology, to physicians of all disciplines is of great importance.

Brain weight in completed suicide and other cases of death-comparison of recent and previous studies.

BACKGROUND: The weight of human brains is subject of numerous scientific research studies particularly in anatomy, pathology, and forensic medicine. Just a few investigations deal with a possible correlation between psychiatric disorders, especially suicidality, and brain weight. The results are contradictory. AIMS: This study aims to find out if postmortem brain weight is higher in suicide victims considering the discrepancies of previous studies. METHOD: In a retrospective study, the weight of brains obtained by autopsies performed in the Institute of Legal Medicine in Frankfurt, Germany, was evaluated. Data of 99 suicide cases (64 males, 35 females) were compared with those obtained from similar number cases of sudden death in a matched pair analysis. In each case, body weight, height, and body mass index were also taken into account. RESULTS: No significant differences in brain weight were found in suicide victims compared to those of the control group. CONCLUSIONS: The brain weight depends on various parameters such as gender, age, body height, and weight. The selection criteria for suicide cases as well as for the corresponding control population are essential in evaluating the brain weight in suicide.

[Relation of external biometric parameters to health risk and mortality--analysis and evaluation of different measurement methods and study results]. / Das Verhältnis ausserer Körpermasse zum Erkrankungsrisiko und zur Todesursache--Analyse und Bewertung unterschiedlicher Messmethoden und Studienergebnisse (I).

In clinical practice diagnoses can be found which are partially based on body measurements. By measuring body height and body weight the patient is categorised, for example by Body-Mass Index (BMI), in different adipose grades. Different diseases are associated with specific biometric parameters. Abdominal adiposity measured by waist circumference correlates with the risk of colon carcinoma and is one diagnostic criteria of the metabolic syndrome. An unhealthy waist-hip ratio (WHR) can cause a higher risk of a cardiovascular disease and dementia. By combining body measurement with cause of death found during the medicolegal autopsy, clinical relevant correlations can be uncovered. Research in medical databases (e.g. PubMed) was carried out to find studies showing possible associations between body measurements, their indices and morbidity or causes of death. This article is a selective survey of these published studies, current guidelines and the German Institute for Standardisation - Norm (DIN-Norm). We give a wide thematic overview and select relevant parameters, which should be taken during medico-legal autopsies in future. The ascertainment of those parameters and their adjustment with the findings of the medico-legal autopsies can be a key to finding predictors of history of disease and relevant morbidity risks in the institutes of forensic medicine. Such findings are very important in the assessment of risk for living patients and necessary preventive actions. Beside the measurement of waist and hip circumference mentioned in specific clinical guidelines in Germany, we suggest, after analysing the parameters, to measure the thickness of the subcutaneous fat on the anterior chest and the thigh circumference as well.

[Taking venous blood samples in the daily routine of German hospitals]. / Die venöse Blutentnahme im klinischen Alltag.

BACKGROUND AND OBJECTIVE: In Germany, taking blood samples is generally considered to be the task of a physician. Doctors can legally delegate the taking of blood samples to nurses only after having made sure that they are qualified for this task. In daily routine at many hospitals blood samples are almost always taken by doctors and nearly exclusively by qualified assistants in the medical practices of resident doctors. METHODS: Answers to standardized questionnaires by 538 nurses were analysed for the way in which five German hospitals of a corporate group of hospitals dealt with this task, and what circumstances and reasons played a role. RESULTS: It was found that in the East German states blood samples were significantly more often taken by nurses than in the rest of the Federal Republic. 476 of all nurses questioned (89.14% of total) considered themselves capable of taking blood samples. However taking these samples has remained part of doctors' daily routine. CONCLUSION: In times of necessary cost cutting and a growing lack of physicians it would be reasonable to delegate this task to nurses who have been specifically trained for it.

[Early symptoms and causes of sudden death related to sports activities]. / Vorzeichen und Ursachen des plötzlichen Todes im Zusammenhang mit sportlicher Betätigung.

BACKGROUND: This study provides an overview on presymptoms and causes of sport-related death and suggests preventive measures. METHODS: 29 436 autopsies of the Centre of Legal Medicine at the University of Frankfurt/Main from 1972 to 2001 were analysed and compared with a control group. RESULTS: 96 men (95 %, average age 53.3 years) and 5 women (5 %, average age 36.4 years) were involved in 101 fatalities connected with sports (0.34 % of all autopsies). 78 athletes (77.2 %) died during, 20 (19.8 %) immediately after sport activities. Immediately before death 18 of 50 persons concerned were free of symptoms, twelve complained of nausea and vomiting, seven of vertigo, five of weakness, four of epigastric pain and dyspnoea, three exhibited angina pectoris symptoms. The day before death 7 of 25 athletes had symptoms like angina pectoris, nausea, backache and palpitation. 84 fatalities (83.2 %) were due to coronary heart disease. Seven were due to myocarditis (6.9 %), in four cases (26.7 %) among athletes younger than 36. Among children and adolescents (n = 4) myocarditis, cardiomyopathy and in two cases a valvular defect of the heart were the cause of death. In comparison to controls death in elder athletes due to coronary heart disease and myocardial infarction was high significantly more common and athletes died significantly younger. CONCLUSIONS: Further prospective investigations are needed to provide strategies for prevention.

[Seasonal variations in sudden death in sports clubs]. / Saisonale Schwankungen plötzlicher Todesfälle im Vereinssport.

2,825 cases of sudden deaths (2,669 men, 156 women) in sports-clubs between 1981 and 1999 were evaluated retrospectively by means of the cosinor method in order to detect a circannual distribution of occurrence. Deaths due to cardiovascular and traumatic events were additionally studied with regard to seasonal differences of frequency. The number of sudden deaths per month during a period of 19 years could be significantly fitted to a cosine model with a maximum in June, the absolute maximum value being observed in May (n = 317). In particular, accidents were more frequently found in spring and summer.

[Organ pathology causing sudden death in athletes. International study of autopsies (Germany, Austria, Switzerland)]. / Organpathologische Ursachen des akuten Sporttodes. Eine internationale Autopsiestudie (Deutschland, Osterreich, Schweiz).

BACKGROUND: Accordance of all studies concerning the distribution of causes of cardiovascular sports deaths can only be registered in the dominating role of coronary heart disease and myocardial infarction among athletes > 35 years. In North America a predominance of hypertrophic cardiomyopathy among younger sportsmen (< or = 35 years) is described. This study investigates the conditions in the German speaking countries in central Europe. PATIENTS AND METHODS: The present prospective and retrospective 1.5-year (July 1996 to December 1997) study is based on post-mortem examinations of 28 institutes of pathology and forensic medicine in Germany, Austria and German speaking Switzerland. RESULTS: Twelve out of 113 cases (10.6%) were females, their age being significantly lower (27.8 years, sd = 15.2) than the age of the males (37.5 years, sd = 16.5). Eighty sports deaths (70.8%) were caused by cardiovascular reasons, 33 sports deaths (29.2%) were traumatic in origin. The main cause of cardiovascular deaths of the older athletes (> 35 years) was the coronary heart disease (84.1%). The main reasons for cardiovascular deaths of younger athletes (< or = 35 years) were the coronary heart disease (36.1%) and myocarditis (30.6%). A case of hypertrophic cardiomyopathy was not registered. Most of sports deaths happened in soccer (28), jogging (15), walking (8), cycling (7) and skiing (7). Most of traumatic sports deaths were registered in aerial sports. Four ball players (soccer n = 3, handball n = 1) and 1 motor cyclist suffered from a thrombosis after an orthopedic injury and died due to a consecutive pulmonary embolism. CONCLUSIONS: The distribution of cardiovascular sports deaths displays astonishing regional differences. In contrast to North America anatomical-pathological studies of German speaking countries do not show any dominance of hypertrophic cardiomyopathy among younger athletes, although the pathologists in recent investigations knew the results of Maron. Possible explanations for this phenomenon might be varying selections of patients (top-performance athletes and hobby sportsmen) or a different genetical background.

[15 years insurance statistics of incidents and accident types of combat sports injuries of the Rhineland-Pfalz Federal Sports Club]. / 15jährige Versicherungsstatistik zu Inzidenzen und Unfallhergangstypen von Kampfsportverletzungen im Landessportbund Rheinland-Pfalz.

The primary intention of this study is the grouping of sports accidents, being described by the athletes in their own words in a classification system of specific accident classes with regard to specific motions and topography. The investigation is based on the data of the sports insurance Gerling-Konzern during a 15-year period in Rhineland Palatinate (1981-1995). The study is based on the insurance documents and clinical protocols if available. 137 accident protocols were related to this 15-year period including weight lifting (n = 1) and martial arts (n = 136). Listed in hierarchical order we received the following results: judo (n = 47), karate (n = 44), wrestling (n = 22), taekwondo (n = 9), boxing (n = 7), ju-jutsu (n = 5), fencing (n = 1) and aikido (n = 1). In accordance to accident types there were no sex related differences. As special preventive measures we suggest the use of protective mouthguards and solid glasses, proprioceptive training and physiological taping for knee, ankle and elbow joints.

[Sudden cardiovascular death during sexual intercourse--results of a legal medicine autopsy study]. / Der plötzliche kardiovaskuläre Tod bei der sexuellen Betätigung--Ergebnisse einer rechtsmedizinischen Obduktionsstudie.

This epidemiologic, retrospective follow-up mortality study is based on the data gathered in the department of forensic medicine at the University Hospital of Johann Wolfgang Goethe University in Frankfurt/Main. Over a period of 21 years (1972-1992), roughly 21,000 forensic autopsies revealed 39 cases (0.19%) of natural deaths occurring during sexual activity. Except for two women, all of these cases were men of an average age of 61.3 years. The most frequent cause of death was myocardial infarction (n = 21/53.8%), three of these cases involving pericardial tamponade accompanied by myomalacia. The medical history of twelve of the deceased showed a previous myocardial infarction. Most of the deaths took place during or after sexual intercourse or manual stimulation. In most cases sudden death occurred during the sexual act with a prostitute. The annual incidence of sudden cardiovascular deaths during sexual activity is estimated to be 0.2/100,000 men. The risk for women is lower by a factor of 12.

[Sudden and unexpected death in athletic club sports in federal Berlin and Brandenburg districts (January 1992-April 1997)]. / Der plötzliche und unerwartete Tod im Vereinssport der Bundesländer Berlin und Brandenburg (Januar 1992-April 1997).

We analysed all the so-called "optical" (= cardiovascular) and traumatic sports deaths in club sports (n = 60) in Berlin and Brandenburg from 1/1992 to 4/1997, based on the data material of the German Lloyd insurance company.

[Sudden sports deaths in the armed forces of Germany]. / Zum plötzlichen Sporttod in der Bundeswehr.

All Soldiers are obliged to participate in sports educational programs of the services, with the exception of severe restrictions due to individual health problems. During sports activities from 1/1989 to 12/1995 7 soldiers died, 3 (i.e. 43%) during soccer games. Based on a troops strength of 370,000 men, we found a yearly incidence of 0.27 sports deaths/100,000 soldiers. This result correlates with the incidence of sports deaths of club athletes in the greatest European sports death study.