[The conferences of the German Society of Legal Medicine in the mirror of history]. / Die Jahrestagungen der Deutschen Gesellschaft für gerichtliche Medizin/Rechtsmedizin im Spiegel der Geschichte: Von Meran bis München.

This article outlines the chronological development of the annual conferences of the German Society of Legal Medicine (DGRM) from 1905 to 2021. The medical and scientific aspects as well as the specific problems of the subject are presented in the context of the respective political and social structures and the conference culture is sketched.

Impact height and wall distance in bloodstain pattern analysis--what patterns of round bloodstains can tell us.

Bloodstain pattern analysis is a routine procedure in forensic cases that involve bleeding wounds. It utilizes geometric principles to determine the sequence of actions causing the bloodshed and the area of origin, that is, from where the blood originated. The patterns formed by circular bloodstains from drops of blood that hit adjacent surfaces at a 90-degree angle are thought to provide indications of the height of the impact. In this study, blunt force exerted against a pool of blood, which was used as a surrogate for a bleeding wound, was carried out for five different impact-to-wall distances. The blunt force consisted of a hammer head that was dropped from a height of 1.5 m. High-speed photography of the impact and trajectories of the projected blood droplets was analysed. The patterns containing bloodstains produced by the droplets were analysed by measuring the circular bloodstains within the patterns. All the experiments showed that there were two distinct patterns or clusters of circular bloodstains that occurred at different heights above the impact site. The two patterns were a result of different fractions of blood that were projected in a garland or crown-like form of a "Worthington splash" after impact. The findings suggest that patterns of circular bloodstains cannot be used as direct indicators of impact height, but combined analysis of their clusters may lead to indirect determination of impact-to-wall distance and area of origin.

Procalcitonin as a postmortem sepsis marker. A comparison of the validity of results obtained from blood serum, aqueous humour and cerebrospinal fluid.

In recent years, serum levels of the prohormone procalcitonin have been investigated in a number of studies in relation to postmortem sepsis diagnostics, as macroscopic and histomorphological findings are, as a rule, nonspecific. However, due to advanced haemolysis, it is often not possible to determine serum procalcitonin (PCT) levels in cases of sepsis-related death. Moreover, the impact of postmortem interval on PCT levels is largely unclarified. In view of this, the present pilot study investigated PCT levels in the serum, aqueous humour, and cerebrospinal fluid in a study population of 25 persons who died of sepsis and a control population of 25 deaths unrelated to sepsis. Using the Mann-Whitney U test, statistically significant differences in PCT levels were determined for all the analysed samples from the study and control populations. Logistic regression analysis was used to calculate cut-off values for sepsis diagnosis for all the sample types. Furthermore, the serum elimination rates published by Tsokos et al. (Int J Legal Med 114:237-243, 2001) were used to calculate the PCT levels at the time of death for the cases with a known postmortem interval. The results of our study demonstrate that, taking account of the postmortem elimination process, it is possible to infer the value at the time of death from the procalcitonin levels measured in all three sample types and to interpret this with the aid of a defined cut-off value. The findings need to be verified based on a larger study population.

Improvement of insulin sensitivity after adrenalectomy in patients with pheochromocytoma.

OBJECTIVE: Decreased insulin secretion is considered to be the main cause for pheochromocytoma-associated diabetes mellitus. Data from animal and evidence from clinical studies suggest that catecholamines can induce insulin resistance. However, there is no study investigating the effect of catecholamine excess on insulin resistance in patients with pheochromocytopma by the euglycemic hyperinsulinaemic clamp technique. RESEARCH DESIGN AND METHODS: We characterized the effect of high catecholamine plasma concentrations on glucose metabolism and insulin resistance. Euglycemic hyperinsulinemic clamps were performed in 10 patients with pheochromocytoma with and without diabetes mellitus before and 5 wk after adrenalectomy. RESULTS: In five patients with diabetes mellitus, glucose infusion rate required to maintain euglycemia during the clamp (mean +/- SEM) significantly improved from 27.5 +/- 6.5 micro mol/kg.min before surgery to 44.6 +/- 12.3 micro mol/kg.min 5 wk after adrenalectomy (P < 0.05). In five individuals without diabetes, total glucose disposal improved from 105 +/- 13.6 to 130 +/- 11.2 (P < 0.05). Improved insulin sensitivity after surgery was confirmed by a decrease of fasting hyperinsulinemia from 210 +/- 74 pmol/liter (diabetes mellitus) and 69 +/- 9 pmol/liter (no diabetes) before to 134 +/- 56 pmol/liter and 54 +/- 8 after surgery respectively (P < 0.01). In three patients, diabetes and hyperinsulinemia were reversed by the surgical removal of the pheochromocytoma. CONCLUSION: Our data provide evidence that endogenous catecholamine excess in patients with pheochromocytoma can induce or aggravate insulin resistance both in patients with type 2 diabetes and patients with normal glucose tolerance.

Rapid gene inactivation in Pseudomonas aeruginosa.

A rapid and efficient method to inactivate genes in Pseudomonas aeruginosa has been developed. It is based on pKnockout vectors which carry either a gentamicin or a streptomycin/spectinomycin resistance cassette allowing for selection in P. aeruginosa where these vectors do not replicate. A PCR fragment of the gene of interest carrying 5'- and 3'-truncations is cloned into a pKnockout vector, mobilized into P. aeruginosa, and subsequently integrated into the chromosomal copy of the target gene. The orientation of the fragment determines whether (i) the target gene is disrupted without blocking the transcription of downstream genes or (ii) the insertion exerts a polar effect thereby leading to inactivation of a whole operon.

Acromegaly in a family without a mutation in the menin gene.

Familial pituitary tumors are rare. Only 45 cases in 20 families with acromegaly have been reported. A third of the cases (30%) is related to multiple endocrine neoplasia type 1 (MEN 1). We report two cases of acromegaly in one family with pituitary macroadenomas. A 46-year-old woman with elevated serum growth hormone (GH) and insulin-like growth factor (IGF-1) and a failure to supress GH in the glucose tolerance test underwent transsphenoidal surgery 4 years ago. Three years later her 24-year-old son also presented with typical signs of acromegaly. A pituitary macroadenoma was identified by MRT and he also underwent transsphenoidal surgery. There were no symptoms of McCune-Albright syndrome or other forms of endocrine hyperfunction in the two patients. In an attempt to identify the molecular etiology of the tumours DNA was extracted from paraffin fixed tissue from both patients. Exon 7 to 13 of the Gsp-protein and exons 1 to 10 of the menin gene were amplified by PCR. Although Gsp mutations have been identified in 40% of somatotroph tumors, direct sequencing of the PCR products showed no mutations in exons 7 to 13 of Gs alpha. Moreover no mutations were found in exons 1 to 10 of the menin gene. Therefore, molecular causes other than Gsp or menin gene mutations have to be considered as the molecular etiology of acromegaly in this family.