Criteria for age estimation in living individuals.

This paper presents updated recommendations of the Study Group on Forensic Age Diagnostics for age estimations in living individuals in criminal proceedings. In order to increase the diagnostic accuracy and to improve the identification of age-relevant developmental disorders, a physical examination, an X-ray examination of the left hand, as well as a dental examination including the determination of the dental status and an X-ray of the dentition should be performed in each case. If the skeletal development of the hand is completed, an additional radiological examination of the clavicles should be carried out. Minimum requirements for reference studies are defined and recommendable studies are listed. Instructions for the examination and the preparation of expert reports are presented. The committee of the study group organizes annual proficiency tests for quality assurance.

Recommendations for the forensic diagnosis of sex and age from skeletons.

In both diagnostic fields a two-stage strategy is recommended: to first use "field" methods that are quick and easy but more imprecise and then "laboratory" methods that are time consuming but more precise. In preparing skeletal work, individuality of a skeleton should be checked, traces of diseases sought and time since death assessed. For sexing non-adults, the field methods are tooth mineralisation, long bone length and a few morphological skull and pelvis characteristics, for adults it is the morphology of pelvis and skull, and for both age groups the advanced laboratory method is molecular biology. For ageing non-adults the methods are mineralisation of teeth, long bone length and epiphysis development. For ageing adults the advanced laboratory method is aspartic acid racemisation. Less accurate laboratory methods are cement ring counts and histology of bones and teeth. Quick morphological methods using the pubic symphysis and other traits in combinations follow. Finally, cranial sutures and tooth number give a quick and rough impression. For the selection of a method and the assessment of its value the stochastic error produced for the reference sample is the decisive criterion; it should also be used to assess the reliability of a single diagnosis. Prerequisites for all work with skeletons are not only a complete knowledge of the relevant biology as well as specific techniques but also initial detailed instructions and with forensic applications, personal experience.

Age estimation.

While age estimation of unidentified corpses and skeletons for identification purposes has a long tradition in forensic sciences, age estimation of living persons has formed a relatively recent area of forensic research which is becoming increasingly important. The international interdisciplinary Study Group on Forensic Age Diagnostics (AGFAD) issued recommendations for age estimation of living persons for the purpose of criminal, civil, asylum and old-age pension procedures as well as for determining the sex and age of skeletons. In the present work, the authors set out state-of-the art age estimation methods for specific case groups, define minimum requirements for reference studies and specify the need for further research. In addition, ethical and medico-legal aspects as well as issues relating to quality assurance are discussed.

Studies on the progress of third-molar mineralisation in a Black African population.

The forensic determination of the age of living people has become increasingly important in recent years. With regard to the relevant age group, the radiographic assessment of third-molar mineralisation is of particular importance. So far, the influence of geographic origin on the mineralisation rate has been insufficiently analysed. The paper is based on a total of 595 conventional orthopantomograms of 474 male and 121 female Black Africans aged between 10 and 26 years for whom dates of birth were known. The mineralisation status of third molars was evaluated based on Demirjian's classification of stages [Demirjian et al., 1973. A new system of dental age assessment. Hum. Biol. 45, 221-227]. This study presents the means and standard deviations, median values and the lower and upper quartiles separately for both sexes for the mineralisation stages D-H. Statistically significant differences between the upper and lower jaws were observed in males examined with regard to their attaining the stage F. Mandibular teeth developed 0.8 years earlier than maxillary teeth. Significant sex-specific differences were found with regard to the age at which tooth 38 reached the stage G. In females, tooth 38 reached stage G 1.5 years earlier than in males. In comparison to White probands, the Black African sample showed a tendency to achieve the mineralisation stages earlier. We would recommend using population-specific standards for age determination purposes.

Age estimation of unaccompanied minors. Part II. Dental aspects.

Recent years have brought a worldwide increase in cross-border migration due to a globalized economy and ongoing belligerent conflicts. As a result, the percentage of foreigners among the general population has steadily increased not only in Germany, but also in other countries. This trend has triggered a growing demand for forensic medicine to assess the age of adolescents and young adults. The individuals examined here are unaccompanied minors without valid identification documents who do not know their age or else are suspected of not giving their correct age. The mineralization of third molars is the main criterion for dental age estimation of living subjects in the relevant age group. To date insufficient knowledge has been obtained about how ethnic origin can influence tooth mineralization. This, however, constitutes a restraint on the reliability of age estimates and hence on the forensic value of information essential to legal security. A comparative study was conducted to present comparative data on third molar mineralization in a Caucasoid, Mongoloid and African sample. In conclusion, forensic age estimates of living subjects would be more powerful tools if population-specific standards were applied to evaluations of wisdom tooth mineralization. Since the mineralization of third molars is usually completed by the age of 19 or 20 years, this feature cannot be used to ascertain whether a person has attained the forensically relevant age of 21 years. The question was whether determination based on an orthopantomogram of a combination of features relevant to dental age estimation of adults supplies forensically useful information for ascertaining whether a person has attained 21 years of age. The features considered include the DMFT index of all permanent teeth, the DMFT index of all permanent teeth excluding third molars and the DFT index of third molars projecting beyond the occlusal plane. It can be concluded that an evaluation of the variations of the DMFT index does not by itself yield sufficient data to determine with the accuracy required in criminal proceedings whether a person has attained 21 years of age. An additional X-ray examination of the medial clavicular epiphyseal cartilage is, therefore, strongly recommended when assessing whether a person is over 21.

Age estimation of unaccompanied minors. Part I. General considerations.

In recent years many countries have experienced a sharp increase in the demand for forensic age estimates of unaccompanied minors. In many countries the age thresholds of relevance to criminal prosecution lie between 16 and 22 years. In line with recommendations issued by the Study Group on Forensic Age Diagnostics, for determining the age of live subjects a forensic age estimate should combine the results of a physical examination, an X-ray of the hand and a dental examination which records dentition status and evaluates an orthopantomogram. To assess the age of persons who are assumed to be at least 18 years old, an additional radiographic or CT examination of the collar bones is recommended. Forensic age estimates should take account of the ethnic origin and socio-economic status of the person under examination.

Combined determination of selected radiological and morphological variables relevant for dental age estimation of young adults.

The mineralisation of third molars is one of the main criteria for dental age estimation of living subjects in criminal proceedings. Since the mineralisation of third molars is usually completed by the age of 19 or 20 years, this feature cannot be used to ascertain whether a person has attained the forensically relevant age of 21 years. This study examined whether determination based on an orthopantomogram of a combination of features relevant to dental age estimation of adults, supplies forensically useful information for ascertaining whether a person has attained 21 years of age. The features considered include the DMFT index of all permanent teeth, the DMFT index of all permanent teeth excluding third molars, the DFT index of third molars projecting beyond the occlusal plane, the eruption of third molars and the periodontal recession of second molars. A total of 650 conventional orthopantomograms of German subjects aged 18-30 years were evaluated. The statistical evaluation of our results was based on a discriminant analysis. It was carried out with two classes defined by two age groups: < or = 21 years and > 21 years. The probability of correct classification was 69.7% for males and 71.4% for females. It can be concluded that an evaluation of the variables reviewed in this paper does not by itself yield sufficient data to determine with the accuracy required in criminal proceedings whether a person has attained 21 years of age. The additional radiographic examination of the medial clavicular epiphyseal cartilage is recommended.

Forensic medicine in the German Democratic Republic.

Forensic medicine services were resumed in the territory of the Soviet occupation zone in early summer 1945. One coherent legal system was established, following the foundation of the German Democratic Republic (GDR), 7 October 1949. Forensic medicine was subject of teaching and examinations from the very outset. Sub-specialisation (fellowship) was introduced in 1955. The Gesellschaft für Gerichtliche Medizin der DDR (GDR Society of Forensic Medicine) was established in 1967 and began to organise with high continuity a wide-ranging variety of scientific events. Almost all administrative districts had their own institute of forensic medicine by 1990.

Forensic age diagnostics of living people undergoing criminal proceedings.

In the German-speaking area, recent years have seen a rapid growth of the need for forensic age estimations. Such need arises, for example, if no verified information on the age of a person suspected of a criminal offence is available; the issue at question in terms of criminal law is whether the person concerned has reached the age of criminal responsibility and whether general criminal law in force for adults is to be applied. The relevant age tresholds in criminal proceedings are 14, 18 and 21 years of age. According to recommendations of the Study Group on Forensic Age Diagnostics, a forensic age estimate should consist of a physical examination, an X-ray of the hand, and a dental examination which records dentition status and evaluates an orthopantomogram. In addition, a radiological or CT examination of the clavicles is recommended to establish whether a person has attained 21 years of age. The present article addresses the influence of ethnic origin on the examined developmental systems.

Age estimation of unidentified corpses by measurement of root translucency.

To evaluate the root dentine translucency technique for age analysis, age estimates carried out at the Institute of Legal Medicine at the Charité University Hospital in Berlin between 1998 and 2002 of unidentified corpses were subjected to retrospective review. Teeth suitable for evaluation were obtained from 33 corpses of undisputed identity. Root translucency was measured at intervals of half a millimetre. Appropriate reference studies were used to translate the measurements obtained into estimated age. In 18 cases these estimates proved correct. In 14 cases the deviation lay within +/-10 years. In one case of known drug abuse combined with diabetic metabolism, two factors which promote the advance of root translucency, the deviation was 12 years. It was concluded that the described technique, which requires little time and money and is easy to apply, can produce sound results in the middle age group (30-60). To avoid seriously inaccurate estimates in individual cases, the result should always be verified critically against an assessment of the overall stomatognathic system and other post-mortem findings of relevance to age.

Reduced intensity conditioning and prophylactic DLI can cure patients with high-risk acute leukaemias if complete donor chimerism can be achieved.

23 patients with ALL (n=9) and AML (n=14) underwent nonmyeloablative stem cell transplantation (NST) from an HLA-identical donor after conditioning with fludarabine (180 mg/m(2)), busulfan (8 mg/kg) and anti-T-lymphocyte globulin (40 mg/kg). After NST, 20/23 patients engrafted. Ten out of 14 patients with uncontrolled disease reached complete remission. A multiplex-PCR using short tandem repeats was used for chimerism analysis and detected mixed chimerism (MC) in 14/22 evaluable patients (64%) after NST. Prophylactic donor lymphocyte infusions (DLI) were given to 11/14 patients with MC; MC converted to complete donor chimerism (CC) in 6/11 patients within 2-6 weeks. All patients with persistent MC with or without DLI relapsed during further follow-up. MC predicted impending relapse 4-52 weeks before clinical diagnosis. Ten of 23 patients (43%) are alive 2-34 months after stem cell transplantation. 12 of 23 patients (52%), have died from leukaemia after NST. One out of 23 patients has died from severe sepsis. In conclusion, NST leads to stable engraftment and complete remission in patients with advanced acute leukaemias. NST can cure a substantial proportion of these patients, but the relapse rate is still high. Repeated chimerism analysis is a useful tool to detect recipient cells, especially in patients without molecular markers of disease and can be used to monitor immunomodulatory therapies. MC is unstable in these patients and predicts impending relapse. Prophylactic DLI can convert MC to CC, which seemed to lower relapse risk.

Forensic age diagnostics of living individuals in criminal proceedings.

Age estimations of living individuals are increasingly important in criminal matters. If doubts arise regarding the age of a person suspected of a criminal offense, forensic age estimation is prompted by the need to ascertain whether the person concerned has reached the age of criminal responsibility and whether general criminal law in force for older juveniles or adults is to be applied. According to the recommendations of the Arbeitsgemeinschaft für Forensische Altersdiagnostik (study group for forensic age diagnostics), age estimates in criminal proceedings should be based on the general physical examination, the X-ray examination of the hand and the odontological examination by a dentist, including dental status and orthopantomogram. In order to improve diagnostic reliability, these methods should always be used in combination, ensuring that each part is performed by forensically trained and experienced experts of the relevant disciplines. In order to demonstrate that the proband has reached the age of 21, an additional X-ray examination or CT scan of the clavicles is recommended. Future research projects should assess the variation for a combination of the above methods, quantify the impact of socio-economic status and ethnicity on the examined development systems and review the suitability of non-ionizing imaging methods of age estimation.

Kicking to death - forensic and criminological aspects.

A total of 36,274 forensic autopsies was performed in Berlin, between 1980 and 1987, including 152 cases (0.42%) in which death had been caused by blunt violence due to kicking. Data were collected on both victims and offenders, postmortem findings, causes of death and the way violence had been perpetrated. The greater part of victims and offenders had been males originating from lower social strata. Most of the victims and offenders had been in relationship with each other prior to the offence. Typical course of events: Victims and offenders, under influence of alcohol, became involved in a brawl, usually for trivial reasons, which soon led to physical fighting. When the victim had been knocked to the ground, the offender started forceful kicking. Bleeding to death and head injury were frequent causes of death. More than 50% of all offences were committed by single offenders. The diagnosis of kicking to death can at best be derived from presence of boot traces leaving shaped injuries. The trace-generating boot can be identified as offending tool by means of comparative police investigation. In addition to evaluation of shoe sole profiles, there is other trace-relevant material that may be sampled from a suspected offender's footwear (skin cells, hair, blood, body tissue) and used to identify findings by DNA analysis. There may be injuries with visible patterns supporting suspicion of kicking and trampling, although conclusive confirmation can be obtained only by testimony by a witness or confession by the offender.

[An unusual autoerotic accident: sexual pleasure from peritoneal pain]. / Ein ungewöhnlicher autoerotischer Unfall: sexueller Lustgewinn durch Peritonealschmerz.

The paper describes a fatal autoerotic accident of a 23-year-old man who derived sexual pleasure from painful irritation of the peritoneum by sharp force. For this purpose he clamped two knife blades into a vice suspended from a rope-pulley construction so that he could lower it to pierce the abdominal skin with the tips of the knives. When one of the ropes broke, the vice with the knives fell onto the man's belly piercing the inferior vena cava and leading to death by exsanguination. This, to the authors' knowledge, has been the first ever report of a fatal autoerotic accident in which sexual pleasure was to be obtained from painful irritation of the peritoneum.

Effects of ethnicity on skeletal maturation: consequences for forensic age estimations.

An X-ray of the hand is an important method in forensic science for estimation of the age of juvenile suspects with uncertain date of birth. Relevant X-ray standards for evaluation of skeletal maturity are available for white US Americans as well as for North and Central Europeans. The applicability of these standards to members of ethnic groups different from the reference population has been the subject of controversial discussion. More than 80 publications were analysed with the view to finding out whether skeletal maturation is affected by ethnic identity. It was concluded that skeletal maturation takes place in phases which are identically defined for all ethnic groups. Time-related differences in passing those stages of skeletal maturation within the relevant age group appear to be unaffected by ethnic identity. It is the socioeconomic status of a given population which is of decisive importance to the rate of ossification. The application of X-ray standards to individuals of a socio-economic status lower than that of the reference population usually leads to underestimation of that person's age. In terms of criminal responsibility, this is of no adverse effect on the person concerned.