All mixed up?-genotype change after stem cell transplantation impeded verification of 21-year-old semen sample-a case report.

We report a case of identity testing in which a patient charged us with the verification of a semen sample that he had donated and cryopreserved more than 20 years ago and now was suspecting of having been inadvertently interchanged. We found a non-match of the DNA profiles of the patient's blood and the semen samples but could show that this was due to the patient having received a stem cell transplantation of his full brother as part of a cancer therapy in 1997 which was not known to us when the samples were first tested. Also, the blood and semen samples exhibited a low probability of full sibship at first supporting the patient's suspicion that his semen sample might indeed have been interchanged. By also testing Y-STRs and including hair roots in the DNA analysis, we could show that the transplant did indeed originate from the patient's brother and that the semen sample did indeed originate from the patient.

[Unusual questions of evidence in a case of offensive post-mortem dismemberment]. / Ungewõihnliche Beweisfragen in einem Fall von offensiver Leichenzerstückelung.

In cases of post-mortem dismemberment, the main medicolegal task apart from the identification and assignment of body parts to one or several individuals is the determination of the cause of death and the course of events. Notably in cases of offensive postmortem dismemberment, the medicolegal findings on the victim may be of special importance also for the psychiatric evaluation of the suspect. In a case of offensive post-mortem dismemberment, parts of the body were found in a stone quarry and in the apartment where the victim and the suspect had lived together. Since the suspect refused to make a statement, the medicolegal findings were of great relevance for the psychiatric evaluation. In the first trial, in which the psychiatric expert was not present when the forensic pathologist gave his opinion, the Regional Court acquitted the suspect of murder and committed him to a psychiatric hospital. The accused successfully appealed on points of law, as the form and content of the psychiatric expert opinion did not comply with the requirements of procedural law and the forensic psychiatric state of the art. In a second trial, additional psychiatric experts were summoned. In that hearing, the task of the medicolegal expert was to reconstruct the course of events as far as possible to create a reliable basis for the psychiatric evaluation, as the suspect refused to make a statement both with regard to his personal circumstances and the facts of the case and did not agree to a psychiatric exploration either. The motivational and morphological criteria of the medicolegal classification as offensive post-mortem dismemberment with a cannibalistic background are discussed. In addition, some issues to be answered such as the detection of bloodstains on nonporous surfaces by means of leucocrystalviolet and the time of heat exposure of burned body parts are dealt with.

DNA transfer to firearms in alternative realistic handling scenarios.

Firearms are the most relevant items of evidence in gun-related crimes, likely bearing various traces facilitating an objective reconstruction of the crime. Trace DNA recovered from firearm surfaces might help to identify individual(s) having handled the firearm and thereby possibly to link the firearm and the corresponding shooter, however, the interpretation of DNA traces on handled items can be challenging and requires a detailed understanding of various factors impacting DNA prevalence, transfer, persistence and recovery. Herein, we aimed at improving our understanding of factors affecting the variability of trace DNA characteristics recovered from firearms handled in gun-related crimes: Skin contact traces were recovered from various outer surfaces of two types of firearms handled in four realistic, casework-relevant handling scenarios and the corresponding trace characteristics (DNA yield, number of contributors, relative profile contribution for known and unknown contributors, LRs) were compared. Trace DNA characteristics differed distinctly between handling conditions, firearm and surface types as well as handling individuals and intraindividual deposits emphasizing the variability and complexity of trace DNA profile composition expected to be recovered from firearms after realistic handling scenarios. The obtained results can provide useful insights for forensic experts evaluating alternative activity level propositions in gun-related crimes.

Gerhart Panning (1900-1944): a German forensic pathologist and his involvement in Nazi crimes during Second World War.

Twenty years after the Second World War the public were made aware of War Crimes committed by the German forensic pathologist, Gerhart Panning (1900-1944). From 1942 till 1944, Panning was professor at the Institute of Forensic Medicine at the University of Bonn. Panning died of tuberculosis on 22 March 1944. After the Second World War, Panning's widow tried to obtain denazification for her husband. There were no particularly serious doubts. In 1965, Konrad Graf von Moltke, the son of Helmuth James Graf von Moltke (1907-1944), presented to the court a private letter from his father to his mother. In this letter, written in 1941, Panning's experiments on Soviet prisoners are described. In the so-called Callsen trial in the court of Darmstadt from 1960 to 1968, the experiments were confirmed by witnesses. In 1941, Panning performed experiments in cooperation with the Sicherheitsstaffel (Nazi special police) in the Ukraine to prove that captured ammunition of the soviet infantry violated international law. For this purpose, different parts of the bodies of living Soviets were used as firing targets. He published the results of these experiments in a scientific journal without any evidence of the origin of these observations. In this article, Panning's life and crimes have been described.

[Death after anal "fisting"]. / Tod nach analem 'Fisting".

A 45-year-old homeless woman was found dead at her usual sleeping place. Apart from traces of blood on the lower abdomen of the body, the police investigations did not produce any clues pointing to an unnatural death. At autopsy, it was found, however, that death had been caused by extensive disruptions of the intestine. After being confronted with the results, the sexual partner of the victim admitted manual anal penetration, but claimed that this had been done by mutual agreement. The court did not accept that statement and sentenced him to life imprisonment for murder. The frequency of such fatal outcomes of anal penetration, the relationship between the perpetrator and the victim and the special features at the scene are discussed.

[Suicide with acetylsalicylic acid]. / Suizid durch Salicylat-Intoxikation.

The authors report on a suicide of a 41-year-old man with acetylsalicylic acid. According to his own statement the man had taken about 200 tablets of Aspirin (65 g acetylsalicylic acid) and initially showed no symptoms of intoxication. 4-5 hours after ingestion he vomited twice, but clear intoxication symptoms like convulsions and cardiac arrhythmia occurred not earlier than 11 hours after ingestion. Resuscitation by the emergency physician was not successful. The chemical-toxicological analysis (HPLC-DAD) of blood samples taken in the hospital approximately 12 h after ingestion showed salicylate in concentrations of 475 mg/L to 557 mg/L. The post-mortem concentrations of salicylate were within the lethal-toxic range, i.e. 762 mg/L in heart blood and 215 mg/L in femoral blood. All tested organs contained equally lethal salicylate levels (e.g. 503 mg/L in the liver and 251 mg/L in the brain).

[Lethal mixed intoxication with propofol in a medical layman]. / Letale Propofol-Mischintoxikation bei einem medizinischen Laien.

The authors report on a drug fatality of a 21-year-old man with a propofol (2,6-di-isopropylphenol) dependency. Propofol was detected in tissues and body fluids using SPME-GC/MS methods. The postmortem concentrations of propofol were 364 ng/ml in urine, 71 ng/ml in heart blood and 79 ng/ml in femoral blood. The drug addict had only an autodidactic medical knowledge, but had inserted himself a permanent cannula for intravenous injection of propofol several times a day. The injection material was bought via online auctions from eBay. The case illustrates how job-related drug dependencies become indistinct due to the free access to information and goods via the Internet.

An unusual occupational accident: fall into a sewage plant tank with lethal outcome.

Occupational accidents, often presenting with lethal outcomes, are a rarely reported issue in forensic literature. However, these incidents are part of medicolegal casework with special regard to reconstruction, liabilities and insurance law-related issues, respectively. We report on a lethal occupational accident in a metropolitan sewage plant. When performing routine controls, a technician fell into an overflow sewer and was immediately pulled into a 30 cm diameter drain. Rescue efforts were initiated immediately, but had to be terminated due to gas warning. Rescue teams continued the search, however, the body remained undiscoverable. Forty-eight hours later, the cadaver was found in an adjacent digester tank, from where it was finally rescued. It was concluded, that the body had been transported between the overflow sewer and the digester tank through a 120 m pipeline with several 90 degrees bendings and branch connections with a minimum diameter of 25 cm at the discharge valve. On medicolegal examination, the cadaver showed marked signs of advanced decomposition caused by anaerobic microorganisms in the 37 degrees C biomass environment. Moreover, as a consequence of the passage of the pipeline system, signs of massive trauma (several comminuted and compound fractures) were disclosed at autopsy. To us, this is the first report on a lethal occupational accident in a sewage plant; our observations demonstrate the rapid progress of putrefaction in a warm anaerobic bacterial environment and the massive trauma sustained.

Retrospective analysis of fatal falls.

Fatal falls are frequent and inhomogeneous events and affect every age. The criminalistic classification can often only be done on the basis of extensive investigations and the autopsy results. We retrospectively surveyed 291 cases of fatal falls on which a post-mortem examination had been carried out in the institutes of Forensic Medicine in Bonn and Greifswald. In large part, these cases are falls from height (n=123) and ground-level falls (n=122). These are compared to fatal falls down a stairs (n=46); the analysis is confined to injuries to the cranium. In ground-level falls the injury pattern in falls under the influence of alcohol differs from that of falls with no alcohol in the case history: all injuries are seen in higher relative frequency in casualties after the consumption of alcohol. In falls from height, the previous consumption of alcohol did not influence the injury pattern; the intracranial traumas are seen in decreasing frequency with increasing heights. The aim of this retrospective analysis is to present injury patterns and influencing factors like fall heights and alcohol for the different kinds of falls on the basis of our collective and to demonstrate similarities and differences between the subgroups.

Medical malpractice as reflected by the forensic evaluation of 4450 autopsies.

A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. In more than 40% of the cases preliminary proceedings were started because the manner of death was certified as non-natural or not clarified. Hospital doctors were more affected by medical malpractice claims than doctors in private practice. However, the number of confirmed cases of medical malpractice was higher for doctors in private practice than for hospital doctors. Although surgery is still at the top of the disciplines involved in medical malpractice claims the number of confirmed surgical cases was below the average. Mistakes in care were confirmed to be above the average. Medico-legal autopsies are still a very sufficient method to evaluate cases of medical malpractice: 2863 cases could already be clarified by autopsy. Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases.

Medical malpractice charges in Germany--a survey.

Since decades, studies concerning medical malpractice charges in Germany were published, written by forensic pathologists and regarding lethal courses and the question of causality. Previously published studies comprise higher numbers of medical malpractice charges and determine who e.g. informed the prosecution, which clinical subjects are involved, the kind of charges and whether such allegations can be appropriately assessed by means of a forensic autopsy. A survey is given, focusing on the results of studies from German Institutes of Forensic Medicine.

Medical negligence in drug associated deaths.

According to epidemiological studies adverse drug events are one of the most frequently encountered complications during medical treatment, a leading cause of hospitalisation and frequent cause of death. However, medical malpractice claims due to medication errors seem to be relatively rare. Based on a retrospective multicentre study on medical malpractice cases with lethal outcome (n=4450), drug related cases (n=575) were further evaluated. In 50% of cases a causal connection between drug therapy and death could be ruled out already after autopsy. In 232 cases a causal connection between drug therapy and death could be approved (drug allergies, relative overdose, wrong application, mix-up of drugs and sepsis after injection abscess). However, within the legal context only in 70 cases a medication error was approved which was in 42 cases causal for death, in 28 not. Administration of contraindicated drugs, incorrect application and relative overdose in renal insufficiency are the prevalent mistakes. Concerning the frequency of ADE in epidemiological studies medication errors are underreported in all data sources on medical malpractice; this seems to be due to the fact that even doctors and attending physicians rarely recognize an ADE; furthermore approving the connection between drug effect and death is extremely difficult for the expert witness.

Heroin-associated nephropathy.

Since the first reports in the late 1960s and early 1970s there have been numerous studies describing the clinical and pathological features of renal diseases associated with chronic parenteral abuse of heroin, cocaine, morphine, amphetamine, and other narcotic and hallucinogenic drugs, including several adulterants. The past 35 years have witnessed an explosive growth in illicit drug use in many parts of the world. Meanwhile, drug addict nephropathy constitutes an important cause of end-stage renal disease. The term heroin-associated nephropathy' includes different morphological findings following chronic drug abuse. Up to now it still remains ambiguous as to whether or not heroin/morphine itself, adulterants, other diseases like hepatitis B and C infection, or HIV, lead to a spectrum of morphologically described heroin-associated' findings in the kidneys. As a measure of prevention it appears that the purity of heroin plays an important role.