Accidental head explosion: an unusual blast wave injury as a result of self-made fireworks.

A 33-year old hobby pyrotechnician sustained a lethal craniofacial trauma secondary to a salute fireworks blast. He was examining a misfire of a self-constructed salute gun, when it detonated, causing an explosively rupture of his forehead, which led to his immediate death. An autopsy was performed to achieve knowledge of the injury and to be able to reconstruct the events that lead to it. The pressure effect of the explosion caused a shredded rupture of the forehead with a regional spread of brain tissue and small polygonal skull fragments up to 30m from the detonation site. Furthermore multiple cinderlike fragments of black powder were embedded in the skin of the face and the anterior aspect of the neck (s.c. blast tattoo). The complete destruction of the forehead in combination with the multiple blast tattooing suggested that the explosion detonated while he was leaning over the device.

[Death in seclusion - a worldwide phenomenon illustrated on fringe groups in Munich]. / Der Einsame Tod - Sterben in Randgruppen in München.

100 randomised cases where a person lived and died in isolation in Munich were analysed. Factors such as social background, living situation, education, physiological and psychological state of health were evaluated. Personal isolation (=seclusion) seems to depend on various social, financial, psychological or physical reasons. Lack of contact with other people not only leads to psychological problems, but isolation also contributes to increased illness and early death. In order to improve the present social situation in Munich preventive social measures are necessary to achieve increase in health status for the elder and a decrease in mortality rate.

[Self-mutilation from a forensic medicine viewpoint]. / Selbst verletzendes Verhalten aus rechtsmedizinischer Sicht.

The frequency of the diagnosis of self-induced injuries is rising, especially in patients with borderline personality disorder. The number of unreported cases is estimated to be high. Self-mutilation typically affects the patient's skin and therefore often presents to dermatologists or general practitioners. Such injuries are often clinically typical; a knowledge of these features is essential for the correct diagnosis and treatment. Multidisciplinary care is essential because of the tendency for overlap with other psychiatric diseases and the risk of suicide. Self-induced injuries are also used to simulate criminal offences and to fraudulently obtain insurance payments. In these cases appropriate diagnosis is important from both a legal and psychiatric point of view. Typical morphological aspects and combination of clinical signs in cases of self-mutilation are presented from forensic point of view to facilitate confirming the diagnosis.

[Typical findings of maltreated children]. / So differenzieren Sie zwischen Unfall und Cewalttat. Indizien der Kindesmisshandlung.

Childhood maltreatment manifests in a variety of forms and the underlying causes are manifold. In contrast to other offences involving physical injury, reporting behavior has, statistically speaking, remained unchanged. Patterns of injury must first be established and documented, and this involves a complete examination of the child's body. Depending on the constellation of findings, a radiological diagnosis is usually necessary. When all the findings have been collected, the further steps to be taken--where indicated a report to the police--must be discussed. All the evidence must be recorded, and photos obtained of all externally visible injuries before they fade. It is not the task of the physician to develop criminalistic ambitions, for example, by grilling (a parent) on the cause of the injuries. However, he/she has a duty to do everything necessary to protect the well-being of the child.

[Self-inflicted injurious behavior]. / Schnitte ins eigene Fleisch. Warum tun sie sich das an?

Self-inflicted injurious behavior Auto-aggressive behavior such as the simulation of crimes, attempted insurance fraud or suicidal intent are observed in psychiatric diseases and, in particular, in borderline personality disorder. The self-inflicted injuries often show typical characteristics, the knowledge of which is helpful for making a diagnosis and can critically influence further therapy. Borderliner injuries are often noticeably uniform, arranged in parallel, superficial and on body locations that are easily reached. For affected persons who are at high risk for suicide, it is of great importance that they receive psychiatric therapy as soon as possible.