Pulmonary thromboembolism and obesity in forensic pathologic case work.

328 autopsy cases of fatal pulmonary thromboembolism (PE) were compared to 984 age- and sex-matched controls to evaluate the association between obesity and PE in a forensic context. Both PE and control cases had a mean age of 67,8 years (male 62,9 years, females 71,7 years). The percentage of morbidly obese persons with a body mass index (BMI) of above 40 or abdominal subcutaneous adipose tissue of above 4 cm was higher in the PE group (8,39% vs. 4,67% and 29.45% vs. 23.40%, respectively). On the other side, that of very slim persons (BMI below 18.5 or adipose tissue below 3 cm) was significantly smaller (4,27% vs. 7,52% and 47.55% vs. 56,60%). We thus found a strong association between being overweight and death from PE, while slim persons seem to be at an advantage. As the group of underweight persons includes those suffering from chronic diseases with reduced mobility or hypercoagulability (e.g. tumor kachexia or sarkopenia due to immobilisation), this finding is to some extent unexpected.

Fatal anogenital exenteration of the intestine.

A case of a sadistically motivated homicide with extraordinary injuries is reported. A 32-year-old woman was naked with signs of severe blunt trauma and oral, vaginal and anal penetration. At the crime scene, the intestine lay next to the woman without connection to the body. During the trial before the criminal court, the perpetrator admitted fisting and inserting several objects into the vagina, anus and oral cavity. Moreover, after anal and vaginal insertion of the hands, large parts of the intestine were torn and pulled out through the anus and the vagina. The results of the forensic pathological examination and additional investigation are discussed and compared with the pertinent literature. This extraordinary case of a sadistically motivated homicide ended with a final judgment that is extremely rare in German jurisdiction.

Homicide-suicide, double suicide or homicide followed by suicide 2 case reports.

Cases in which several persons who died from an unnatural cause are found together are often difficult. It is necessary to exclude homicide committed by another person and to clarify whether the deaths are the result of a homicide-suicide or a joint suicide of persons wishing to die. Two cases in which couples with gunshot wounds to the head had been found lifeless in their homes are presented. In both cases, the deceased were of advanced ages and suffered from severe pre-existing diseases. Due to the circumstances at the scene, the results of the investigations and the autopsies as well as the suicide notes found, a double suicide was assumed in both cases. The husbands killed themselves after shooting their wives. Based on the presented cases the so-called double suicide and the need for a thorough investigation of the death scene with the problem of differentiating it from homicide-suicide and double homicide are discussed.

Subnuclear lipid-containing vacuolization in cases of ketoacidosis - correlation of morphological findings and ketone body concentrations.

In a study on alcoholics, diabetics, cases of hypothermia, combinations of alcoholism, diabetes and hypothermia as well as 55 controls, ketone body measurements were performed in femoral vein blood, heart blood, vitreous humor, cerebrospinal fluid and urine. Histological investigations were carried out on the kidneys of the deceased. In addition to HE-staining, the cuts were stained with Sudan and PAS to allow differentiation between lipids and glycogens. The degree of stainability in the Sudan stains was correlated with the ketone body concentrations measured. In those cases in which elevated ketone body concentrations were measured, marked fat deposits in the renal tubular epithelial cells could be demonstrated with the Sudan staining method. The higher the stainability the higher the ketone body concentrations. The ketone body concentrations measured in the various body fluids correlated with the intensity of fat stainability.

,,Aorta angust'' - a possible cause of sudden death?.

Over one year, 7 autopsy cases with narrow diameters of the descending aorta were seen in the Institute of Forensic Medicine at the University of Bonn. The autopsy results were supplemented by chemical-toxicological, alcohol and histological examinations. In all cases middle-aged men (24-38 years) died suddenly and predominantly in a domestic environment. To some extent the inner aortic diameters ranged significantly below the expected values in relation to body surfaces or were lower than the 5th percentile related to men aged 45 years. In four cases, potentially lethal concentrations of alcohol or intoxications, e.g. with heroin, were noted. In one case, the blood sugar level was significantly elevated. In the other two cases, all further investigations were unremarkable.

[Sudden death of a 16-year-old girl with WPW syndrome: a case report]. / Plötzliches Versterben einer 16-Jährigen mit WPW-Syndrom: ein Fallbericht.

The Wolff-Parkinson-White syndrome is a usually benign heart disease with accessory pathways. Circling excitations arise between atria and ventricles which can lead to cardiac arrhythmias. Cases of sudden cardiac death are rare (0.2 %). Risk factors for sudden cardiac death in patients with WPW syndrome are old age, several accessory pathways, male sex and previous syncopes. A 16-year-old girl was found lying dead in her bed. The evening before, she didn't feel well and complained about abdominal pain. The girl had known epilepsy and Wolff- Parkinson-White syndrome. The macroscopic and histological findings are presented and discussed with reference to the pertinent literature.

[Death by alcoholic ketoacidosis--analytical procedure and case report]. / Tod infolge alkoholischer Ketoazidose--analytisches Vorgehen und Fallbeispiel.

Alcoholic ketoacidosis is a medical emergency, which is characterized at first by an elevated level of ketone bodies. The production of these ketone bodies is accompanied by an equimolar quantity of hydrogen ions and thus causes acidosis, which cannot be detected post-mortem due to anaerobic glycolysis, whereas the three ketone bodies beta-hydroxybutyrate, acetoacetate and acetone can be easily identified. However, the limits of ketone body concentrations mentioned in the literature for diagnosing ketoacidosis vary significantly, partly due to inhomogeneous study groups. A 44-year-old woman was found dead with numerous haematomas and partial mummification. Some days before, she had reported her partner to the police for rape. Consequently investigations for homicide were initiated. The autopsy itself did not reveal any morphologically identifiable cause of death. The ketone body concentrations in three matrices (vitreous humour, cerebrospinal fluid, cardiac blood) left no doubt that death was due to alcoholic ketoacidosis.

[Death after the intake of amphetamine/ecstasy: two case reports]. / Todesfälle nach der Einnahme von Amphetamin/Ecstasy: zwei Fallvorstellungen.

Synthetic amphetamines such as 3,4-methylenedioxy-N-methylamphetamine (MDMA, Ecstasy) have become recreational drugs in German discotheques because of their euphoric and mood-brightening effects. However, their consumption involves considerable risks, which may even be lethal under certain circumstances. A 19-year-old man was taken to a university hospital for suspected intoxication with a narcotic drug, where he died the next day. As cause of death "fulminant liver failure" was diagnosed. In blood from the femoral vein, MDMA was found in a concentration of 4.27 mg/l. Histological examination showed acute necrosis of the liver and parenchymatous bleeding. The second case is that of a 39-year-old man who collapsed at his workplace and died in hospital shortly afterwards. In his rucksack, a small bag with 1.6 g of amphetamine was found. Analysis of blood from the femoral vein showed an amphetamine concentration of 1.08 mg/l.

[Suicide in childhood or accidental hanging? A case report]. / Suizid im Kindesalter oder unfallbedingtes Erhängen? Eine Fallvorstellung.

Suicides of children, adolescents and young adults are a rare manner of death. Hanging is the dominant suicide method in all age groups. Risk factors for suicide at a young age are mental diseases, use of illicit drugs, antisocial behaviour and problems within the family. A 10-year-old boy was found to have hanged himself with a scarf at the handrail of a staircase. He had had school problems and was often sent home earlier as he tended to disturb classes. In the week prior to his death the headmaster of his school had told him that he should better attend another type of school. The deceased's elder brother had recorded a video with his mobile phone some years before showing his sister in a simulated hanging situation. Apart from the macroscopic and microscopic findings of the reported case, the frequency and special characteristics of suicides in childhood and adolescence are discussed.

[Suicidal fall from height after restraint or accident?]. / Suizidaler Sturz aus der Höhe nach Fixierung oder Unfallgeschehen?

Restraining patients is common practice in psychiatric hospitals and is permitted by section 1906 BGB (German Civil Code) if there is a risk of suicide or serious self-damage because of a mental disease or mental disability. Permanent monitoring and supervision during restraints should be obligatory not only in psychiatric hospitals. Nevertheless a number of deaths have occurred during restraints, usually due to strangulation. Reports of cases with suicidal actions after self-release from restraint are rare in the literature. We report on the case of a 45-year-old woman who had suffered from schizophrenia for more than 20 years. After admission to a hospital, she had to be restrained since she became more and more aggressive. When the monitor showed no vital signs any more, nurses checked the patient's room and found an empty bed. The woman was detected lying on the ground in a pool of blood under an open window of the hospital. The cause of death was a polytrauma with leading cranio-cerebral injuries. Obviously the woman had freed herself from the restraining device and committed suicide by jumping out of the window on the third floor.

[Corpse disposal by embedding it in concrete--a rare form of preserving a body over a period of 5 years and 10 months]. / Leichenbeseitigung durch Einbetonieren-- seltene Form der Leichenkonservierung über einen Zeitraum von 5 Jahren und 10 Monaten.

Final disposal of a homicide victim in concrete is rare. Often missing persons are reported to the police, but the right of adults to determine their whereabouts can make it very difficult to locate them. A 40-year-old woman had been missing for 5 years and 10 months. She was found by the police in the cellar of the family's house, packed in airtight plastic film and embedded in concrete. The husband admitted to have killed her by manual strangulation after an argument during which she fell on the head. His statements were confirmed by the findings obtained from the very well preserved body. The autopsy results were generally consistent with manual strangulation. The literature does not contain many case reports on this rare method of disposing of a body. In the reported case, the postmortem period was remarkably long and the corpse was in a good state of preservation.

[Death by explosion of an aerial mine]. / Tod durch Explosion einer Luftmine.

Civilians are rarely killed by military weapons except in times of war. In early 2014, a 50-year-old man died in an explosion of an aerial mine from the Second World War when he was crushing concrete chunks with an excavator at a recycling plant. In the burned operator's cab, the remains of a body were found on the driver's seat. The thorax and the head were missing. Still sticking in the shoe, the right foot severed at the ankle was found about 7 m from the excavator together with numerous small to tiny body parts. At autopsy, the completely disrupted, strongly charred lower torso of a male connected to the left extremities as well as a large number of small tissue fragments and calcined bones were found. According to calculations performed by the seismographical station on the basis of seismic data, only about 45-60 percent of the charge had detonated. The autopsy results illustrate all the more the massive impact of such an explosion.