[Neonaticides in Hamburg, Germany, from 1998 to 2008]. / Tötung von Neugeborenen - Neonatizide in Hamburg von 1998 bis 2008.

In the analyzed period from 1998 to 2008, the autopsies performed at the Hamburg Institute of Legal Medicine included 13 cases in which an investigation for neonaticide had been initiated by the public prosecutor. The killed neonates showed a nearly equal distribution between both sexes. The most common method of neonaticide was suffocation. Most of the perpetrators were young, unmarried primipara with an average educational background. Almost all of them were suffering under psychological stress and had negated their pregnancy. In most cases, birth and neonaticide happened alone in their flat, and there was no medical attendance in any case. In the cases brought to court the women were charged with manslaughter (Section 212 German Criminal Code) and those found guilty were always granted a mitigated sentence pursuant to Section 213 Criminal Code.

[Injuries of the female genitalia in cases of sexual assault]. / Verletzungen weiblicher Geschlechtsorgane nach sexualisierter Gewalt.

Sexual violence is a global problem that particularly affects women and children. A retrospective analysis of 390 clinical-forensic examinations and 120 autopsies regarding injuries of the female genitalia in cases of sexual violence was performed. In the majority of cases no injuries of the female genitalia were found. Autopsy cases showed significantly more (and more serious) injuries of the genitalia than clinical forensic examinations (43 % vs. 25 %; p = 0.0004). Predominantly found were injuries of the external anogenital area, mostly tears or soft tissue lesions. In the current literature, data regarding the rate of injuries in victims of sexual violence vary strongly and their comparability is limited. Regarding the reconstruction of an offence, a forensic examination with an appropriate documentation of the injuries is evidently crucial.

[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.

Abusive head trauma in children: a comparison of male and female perpetrators.

OBJECTIVE: To evaluate the effect of perpetrator gender on victim presentation and outcomes, and perpetrator legal outcomes for abusive head trauma (AHT). METHODS: We performed a retrospective chart review of AHT cases from 1998 to 2008. Patient clinical data and information regarding perpetrator legal outcome was obtained. Relationship of brain injury and retinal hemorrhages (RHs) and differences in categorical variables of perpetrator gender were compared by using Fisher's exact test. Differences in continuous variables between perpetrator gender were compared by using the Mann-Whitney Test. RESULTS: There were 34 cases of AHT with identified perpetrators, 17 of each gender. Mean age of the victims was 9.4 months (SD: 7.8). Thirty-two (94%) had intracranial hemorrhages, 14 (41%) had both primary and secondary brain injury, 28 (82%) had RHs, and 6 (18%) died. The severity of RH was related to the severity of brain injuries (P = .01). The median age for female perpetrators (34 years) was higher than that for males (27 years; P = .001). Six categorical variables were associated with male perpetrator gender: acute presenting symptoms of cardiopulmonary or respiratory arrest (P = .025), worse clinical outcome (P = .012), neurosurgical intervention (P = .037), death (P = .018), perpetrator confession (P = .0001), and conviction (P = .005). CONCLUSIONS: There were significant perpetrator gender differences of AHT in children. Male perpetrators were younger and more likely to confess and be convicted. Victims of male perpetrators had more serious acute presentations and neurosurgical intervention and suffered worse clinical outcomes.

Medico-legal autopsies in Denmark.

INTRODUCTION: At 2.7% in 1970, the Danish medico-legal autopsy frequency was lower than recent frequencies observed in the Nordic countries (4-24%). The aim of this study was to analyse trends in the number and frequency of Danish medico-legal autopsies. MATERIAL AND METHODS: Data were collected from the computerized archives in the Danish departments of forensic medicine, Statistics Denmark and the Danish National Board of Health. RESULTS: During the 1996-2005 study period, a total of 14,990 medico-legal autopsies were performed. This yielded a medico-legal autopsy frequency of between 2.4% and 2.8%. Our results revealed a certain constancy in the number of medico-legal autopsies and frequency of autopsy with regard to manner of death, sex and number, but we also observed changes in the age composition which involved a decrease in the proportion of young (20-39 years) and an increase in the proportion of middle-aged persons (40-59 years). CONCLUSION: Denmark has a lower autopsy frequency than other Nordic countries and this may constitute a problem for quality of death-statistics and research based on autopsy results. If the patterns in medico-legal autopsy frequencies continue, a decrease in the number of medico-legal autopsies is to be expected. As a consequence, education and training of forensic pathologists may be impaired.

[Differential diagnostics of stomach contents showing blue discoloration]. / Zur Differentialdiagnose des blau Verfärbten Mageninhalts.

A 42-year-old man evidently had died from an intoxication. On the basis of the findings at scene it was primarily assumed that the man had ingested a larger quantity of an ethylene glycol-containing antifreeze for suicidal purposes. The man was said to have had an alcohol problem and did not only consume drinking alcohol, but also other alcoholic liquids. At autopsy, a bluish liquid with an aromatic smell was found in the oesophagus and stomach. However, toxicological analyses did not furnish evidence of ethylene glycol--as expected--but a potentially fatal concentration of ethanol (blood alcohol concentration 4.01 per mille). The blue colour (patent blue C.I.42051) came from a liquid used in the wind-screen washer system in winter, which now contains ethanol (denatured with 2-butanone) instead of ethylene glycol. The results of the toxicological findings including the analysis of congener alcohols and the differential diagnostics of blue-coloured stomach contents are discussed.

[Suicide in children, youths and young adults]. / Suizide von Kindern, Jugendlichen und Heranwachsenden.

Suicides among children and youths are tragic events. The suicide cases of children, youths and young adults examined between 1995 and 2009 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analyzed. Altogether, 54 suicides among children, youths and young adults (37 males, 17 females; median age 17.5 years) were evaluated. The suicide victims were predominantly male (68.5%). The vast majority used "hard" methods such as hanging, jumping from a height or being run over by a train. In seven cases (13.0%) psychiatric disorders were known. Seven victims (13.0%) left a suicide note. Suicide was most frequently (40.7%) committed in the open air (40.7%). In addition, the evaluation shows that at the time of committing suicide more than 40% of the youths and adolescents, in whom a chemical toxicological examination was performed, were under the influence of alcohol, medical and/or illegal drugs.

[Superimposition of ante- and post-mortem photographs of tattoos as a means of identification--a case report]. / Superimposition ante- und Postmortaler Bilder von Tätowierungen zur Identitätssicherung - ein Fallbericht.

With the rising number of tattooed people tattoos have become increasingly important for the identification of unknown corpses. Tattoos can be helpful in both phases of the identification process, either by providing clues to the identity of an unknown person or body or as a means of verifying a postulated identity. In the presented case, an ante-mortem photograph of a tattoo was available although it was of poor quality. The respective skin region of the body was photographed from the same angle as the tattoo on the ante-mortem photograph. When superimposing the two photos, the tattoos were found to match and the identity of the body could be verified.

[Identification of an unknown body by means of osteosynthesis material]. / Identifizierung einer Unbekannten Leiche Anhand von Osteosynthesematerial.

The present case describes the identification of an unknown corpse recovered from water by means of two osteosynthesis plates with serial numbers. This method of identification is compared with the pros and cons of other possibilities of identification using medical findings. Although in Western Europe osteosynthesis material is normally removed some months after the operation, autoptic exposure of a suspicious bone may occasionally allow valid, fast and convenient identification of the body, especially if osteosynthesis material with different serial numbers was used.

How can we reduce the number of coroner autopsies? Lessons from Scotland and the Dundee initiative.

Currently the medicolegal dissection rate for England and Wales is 22% (110,000 coronial autopsies for 500,000 deaths per annum), yet there is a general lack of evidence about the utility of and justification for such a high level of activity, which is between double and triple the rate in other jurisdictions. The government is currently consulting on how to reduce the numbers, and the Coroners and Justice Act 2009 is permissive of external examinations as an alternative to dissections. We describe the philosophy and practice of the Scottish system of postmortem external examinations, and the 20-year experience of a local initiative to maximize use of such external examinations. Currently our regional medicolegal dissection rate is 6%, which if applied to England and Wales would reduce the number of dissections from 110,000 to 30,000 per annum, with all of the social, resource and management implications. While the autopsy is an important tool in modern death investigation, an almost automatic recourse to it is inappropriate. In our view external examinations are not only cost-effective but also a necessary element in any death investigative system which wishes to strike an appropriate balance between intrusion by the state and the rights of the bereaved.

Medico-legal autopsy in postoperative hemodynamic collapse following coronary artery bypass surgery.

Sudden unexpected postoperative hemodynamic collapse with a high mortality develops in 1-3% of patients undergoing coronary artery bypass surgery (CABG). The contribution of surgical graft complications to this serious condition is poorly known and their demonstration at autopsy is a challenging task. Isolated CABG was performed in 8,807 patients during 1988-1999. Of the patients, 76 (0.9%) developed sudden postoperative hemodynamic collapse resulting in subsequent emergency reopening of the median sternotomy and open cardiac massage. Further emergency reoperation could be performed in 62 (82%) whereas 14 patients died prior to reoperation and a further 21 did not survive the reoperation or died a few days later. All 35 (46%) patients who did not survive were subjected to medico-legal autopsy combined with postmortem cast angiography. By combining clinical data with autopsy and angiography data, various types of graft complications were observed in 27 (36%, 1.3 per patient) of the 76 patients with hemodynamic collapse. There were no significant differences in the frequency (33 vs. 40%) or number of complicated grafts per patient (1.2 vs. 1.4) between those who survived reoperation and who did not. Autopsy detected 25 major and minor findings not diagnosed clinically. Postmortem cast angiography visualized 2 graft twists not possible to detect by autopsy dissection only. Surgical graft complications were the most frequent single cause for sudden postoperative hemodynamic collapse in CABG patients leading to a fatal outcome in almost half of the cases. Postmortem angiography improved the accuracy of autopsy diagnostics of graft complications.

[An opinion survey about medical autopsy, Saint-Étienne University Hospital: are the French laws of bioethics to be revised?]. / Enquête d'opinion au CHU de Saint-Étienne sur la pratique des autopsies médicales: faut-il réviser la loi de 2004 relative à la bioéthique ?

PURPOSE: The aim of the medical autopsy is to define the causes of a patient's death. Although its rate has dramatically decreased, the post-mortem examination remains one of the basic tools for the assessment of medical care. The objective of this study was to identify the factors influencing the acceptance of medical autopsies. METHODS: A prospective survey was performed using questionnaire that was administered to patients and health care professionals of the Saint-Étienne university hospital. The survey consisted in several questions relating to the autopsy practice (on one's own body) and the knowledge of the procedure. RESULTS: The population surveyed consisted of 186 individuals and 112 health care professionals, including physicians, residents and nurses. The results of the study overall showed a good acceptance of autopsy. Actually, 86% of the individauls and 94.6% of health professionals would not be opposed to their own autopsy (in order to identify the cause of the death, to help relatives bereavement, to foster medical research). The main reasons of medical autopsy opposition include religion belief, body integrity, dignity and respect. Only 42.5% of patients had previously received some information about autopsies, while 33.9% of health care professionals had received a specific formation. CONCLUSION: The rate of refusal of medical autopsy was low in this survey but information relative to this procedure remains insufficient. The current law imposes to look after a nonopposition to medical autopsy of the died individual, including asking his/her relatives that markedly limit the organ donation. Modification of the French bioethical law should be beneficial to increase both medical autopsy organ donation rates.