[Homicide by hypothermia]. / Tötung durch Erfrieren ("Kältemord").

Death due to hypothermia is normally accidental. Homicides by hypothermia are rare and have been observed especially in cases of abandonment of newborns as a method of infanticide and formerly in criminal experiments on humans in the Dachau concentration camp. 3 deaths due to hypothermia are reported, among them two cases of homicide. Intentional killing by hypothermia is rightly classified as murder as it fulfils the criterion of cruelty.

[Self-deliverance or infanticide?]. / Selbsthilfe bei der Geburt oder Tötung des Neugeborenen?

Self-deliverance by a woman in labour is nowadays a very rare event. The authors report the case of a 24-year-old primipara and a newborn of 49 cm length and 2484 g body weight with a complex pattern of injuries on the head, neck, shoulder and back who had breathed for at least 15 to 30 minutes after birth and died from massive craniocerebral trauma and lesions in the oral and cervical region. As one of the experts considered it possible that the skull fractures were exclusively due to the self-deliverance, the woman was acquitted of the charge of manslaughter. This hypothesis is critically discussed on the basis of the presumable course of the delivery and the literature.

Expert witness in paternity testing in Germany.

In Germany, paternity testing can be ordered by a judge as well as by private persons. In the case of private counselling, the expert has the duty to inform the parties on all medical, legal and ethical aspects. Informed consent must be given by each individual included in an exploration of family relationships. Due to the rapid progress of DNA typing in even minute amounts after polymerase chain reaction amplification, genotypes of short tandem repeat systems can be elicited by extraction from single cells. Therefore, the number of unlawful investigations of paternal relationships is steadily increasing. Here the requirements for paternity testing laboratories and sanctions for unlawful exploration of a person's genotypes are discussed. A new Federal law should be drafted.

A proposal for an anonymous living organ donation in Germany.

In Germany, living organ donation of paired and usually not regenerating organs is restricted by law to related individuals, as well as persons who 'obviously entertain an especially intimate personal relationship'. When this law was adopted in 1997, the intention of the legislator was to guarantee the free will of the donor and to exclude any trade of organs. Since then the transplantation of cadaveric organs has not increased. Additional organs were donated from living donors. However, for a number of reasons only a limited array of transplantation centers use living organ donation as a supply facing a steadily increasing number of patients with chronic renal failure. Living organ donation raises a variety of medical, ethical and legal questions. Although transplantation is a generally accepted therapeutic approach for impaired organ function, doctors do not promote it actively. Prospective donor-recipient pairs use the information obtained via internet and other sources before they contact the clinician. Doctors are hesitant to operate a healthy individual for allowing her or him to profit from this organ loss only emotionally or in an altruistic sense. Often a complex relationship between donor and recipient, as well as tissue incompatibility (ABO, HLA) may be additional reasons to restrain from carrying out living organ transplantation. To improve the chances for good organ function and better life quality of the patients we here propose a model for anonymous living organ donation with special reference to kidney transplantation.

Comparative analysis of short tandem repeats and single nucleotide polymorphisms on the Y-chromosome in Germans, Chinese and Thais.

We have typed genomic DNA samples from 95 individuals from Western Germany, 78 individuals from Bangkok/Thailand and 56 individuals from Chengdu/China for 11 Y-chromosomal diallelic polymorphisms and eight short tandem repeat (STR) systems. For single nucleotide polymorphism (SNP) analysis, a rapid method was applied using the single base extension technology (minisequencing) in combination with capillary electrophoresis. PCR products for SRY-8299, Tat, SRY2627, 92R7, SRY1532, M9, M13, M17/M19 and M20 were pooled and used as templates for the commercially available SNaPshot kit. In addition to these ten SNPs we also tested the Y-chromosomal diallelic Alu repeat insertion DYS287 (YAP) by agarose gel electrophoresis as well as the Y-chromosomal STR systems DYS19, DYS389I+II, DYS390, DYS391, DYS392, DYS393 and DYS385 by fluorescent multiplex fragment analysis. Among the 11 diallelic SNP/Alu systems, only six were found to be polymorphic in the three population samples. From these a total number of seven different haplogroups could be identified in the three populations. Of these, five haplogroups were present in Germans, five in Thais, and only two in Chinese. These haplogroup trees clearly represent population-specific structures. Haplogroup 26 is represented at a high frequency in the Thai and Chinese populations whereas it is absent in Germans. The Y-STR data confirm a haplogroup-specific distribution of Y-STR haplotypes. Only a few cases of identical STR haplotypes in the same SNP haplogroups were detected in each of the three populations studied.

[An unusual homicide case with subsequent suicide]. / Aussergewöhnlicher Fall einer Tötung mit anschliessendem Suizid.

In the medicolegal literature reports on homicides followed by suicide, especially in elderly people, are rare. In the present case, the victim, a 79-year-old woman, showed a rather unusual injury pattern: 3 gunshots to the head (with only 2 entrance wounds and 3 intracranial projectiles) and 2 stabs from a knife. The tools used for inflicting the stab wounds (a hunting knife and a double-edged dagger) were left in the victim's body after the offense. The 89-year-old husband hanged himself with an aerial cable after killing his wife. The police investigations and the autopsy findings suggested a combined homicide-suicide. The motive for the offense could be a so-called delusion of poverty associated with symptoms of depression.

The role of an independent and interdisciplinary assessment of research studies with human subjects in Europe and worldwide.

The author reviews the history of human experimentation beginning as documented by holes in human sculls 6000 years before, addressing the first controlled experiments by James Lind and Edward Jenner in the 18th century and ending with the inhuman experiments in Nazi Camps and the Tuskegee case in Alabama in the 20th century. Resting on the Declaration of Helsinki, quite a number of declarations, scientific, national and international guidelines was issued since aiming at enhancing medical research as well as protecting the subjects from harm. Now a dense ethical, legal, scientific and social network exists for investigator initiated and commercial trials for a rich market of the Pharmaceutical Industry. However, pitfalls still occur (e.g., the cases of thalidomide, VIOXX and TGN 1412) as examples that can only be prevented by even more stringent rules and well informed, conscientious, compassionate and responsible performance of all parties involved.

Unassisted childbirth or homicide--different appraisals of severe injuries in a newborn.

A case of a 24-year-old woman who gave birth to a mature newborn is reported. Many injuries at the head, neck and shoulders, back, mouth and throat which at least partly indicated unassisted childbirth were observed during autopsy. Some injuries, especially the different scull fractures were discussed controversially on trial. One expert postulated a coaction of unassisted childbirth and blunt head trauma to be responsible for the exitus. The other expert considered it possible that all injuries could originate from unassisted childbirth. The court consented to the opinion that all injuries could be the consequence of unassisted childbirth and the woman was exculpated from the accusation of manslaughter.

C4A deficiency and nonresponse to hepatitis B vaccination.

BACKGROUND/AIMS: Hepatitis B vaccination failure has been linked to the presence of certain human leukocyte antigen class II alleles. However, the functional background of these associations has remained unclear. Complement component C 4 is encoded within the major histocompatibility complex and is essential for classical pathway activation. METHODS: Healthy individuals (n=4269) were vaccinated in a prospective trial with Engerix B. Nonresponse was classified as anti-HBs<10 U/l after the last vaccination. Seventy-three nonresponders (NR) (1.7%) were identified. For comparison 53 responders (R) (anti-HBs>10 IU/l) were drawn randomly from the same cohort. C4 allotyping was carried out by high-voltage agarose gel electrophoresis and C4alpha-chain typing using sodium dodecyl sulfate-polyacrylamide gel electrophoresis. C4 gene deletions (C4Del) were studied by Southern blot. RESULTS: C4AQ0 alleles were observed in 45/73 (62%) NR compared to 17/53 (32%) R (P=0.001). C4ADel was observed in 24/73 (33%) NR and in 6/52 (12%) R (P=0.006). C4AQO alleles were present in 21/49 (43%) NR without C4Del compared to 10/46 (22%) in R without C4Del (P=0.031). In a logistic regression with DRB1*0301, DRB1*07, DRB1*1301 and C4AQ0 all except for DRB1*0301 showed a significant association. CONCLUSIONS: C4AQ0 shows a DRB1*0301 independent association with vaccine failure. C4AQ0 alleles probably contribute to inefficient complement activation and failure of B cells to secrete anti-HBs.

Differential genetic determination of immune responsiveness to hepatitis B surface antigen and to hepatitis A virus: a vaccination study in twins.

BACKGROUND: The course of viral hepatitis is thought to be affected by genetic host variability and, in particular, by genes of the major histocompatibility locus. Hepatitis A and B vaccination is a useful model to study the effect of host factors on the immune response to viral antigens. We aimed to assess the heritability of the HBsAg (anti-HBs) and anti-hepatitis A virus (anti-HAV) immune response and to estimate the effect of the HLA-DRB1 locus and other genetic loci unlinked to HLA. METHODS: We did an open prospective study and vaccinated 202 twin pairs with a combined recombinant HBsAg/inactivated hepatitis A vaccine. We measured antibodies to HBsAg and HAV and determined HLA-DRB1* alleles. Heritability was calculated based on variance of antibody response within pairs. Model-fitting analyses were done to analyse genetic and environmental components of vaccine responses. FINDINGS: Anti-HBs and anti-HAV showed heritabilities of 0.61 (95% CI 0.41 to 0.81) and 0.36 (-0.02 to 0.73), respectively. For the anti-HBs immune response, 60% of the phenotypic variance was explained by additive genetic and 40% by non-shared environmental effects. The heritability of the HBsAg vaccine response accounted for by the DRB1* locus was estimated to be 0.25, leaving the remaining heritability of 0.36 to other gene loci. INTERPRETATION: Genetic factors have a strong effect on the immune response to HBsAg. Although genes encoded within the MHC are important for this immune response, more than half the heritability is determined outside this complex. Identification of these genes will help us to understand regulation of immune responses to viral proteins.