Definitions of frontal bone inclination: Applicability and quantification.

In sex determination from crania, a "vertical" forehead is considered a female feature, while a "sloping" forehead is considered a male feature. Precise description of frontal inclination with a quantitative measure like an angle is considerably more difficult as it requires accurate identification of clearly defined craniometric points. In the literature, the morphognostic terms "frontal bone inclination," or "frontal profile," are defined in numerous ways. The aim of this study was to determine which of these frontal inclination definitions is best suited for sex estimation. In a study in the context of the digital forensic osteology project, 10 of the frontal angle definitions described in the literature were assessed for their usefulness in sex determination on 211 virtual crania, reconstructed from postmortem CT-data. Custom-developed software was used for the automated measurement of frontal bone inclination angles from lateral-profile, volume-rendered 3D cranial images in which 10 anthropometric landmarks had been manually marked. Discriminant function analysis was performed to determine if satisfactory accuracy rates for the classification of sex could be achieved with defined variables. Four of the ten examined definitions were found to be highly significant for sex determination; three of these, also provided satisfactory intra- and inter-observer reliability. The frontal angle according to Schwalbe provided the best accuracy rate of 75.4% and a critical discriminatory value (separation value) of 88.6°: angles greater than this, suggest female sex; angles smaller than this, suggest male sex. Further, the open-source, custom-developed software introduced here proved compatible with commonly used image-processing and statistical programs and allowed quick, automated, valid measurement of numerous cranial angles. Other craniometric angles can, thus, also be quickly and easily determined with this software.

The use of liquid latex for detecting traces of blood following thermal exposure.

In cases of crimes involving blood, the perpetrators often attempt to remove the traces they have left behind. Setting fire to the crime scene, aside from cleaning measures, seems to achieve this goal and presents a major challenge for crime scene investigators. There is only very little published information available on the effect of fire and extreme heat on blood and the detection thereof. After exposure to high temperatures of or exceeding 1.000 °C, blood is deemed to be undetectable. This study exposed 11 different potentially crime-relevant objects using a standardized and controlled procedure to temperatures of 300 °C, 700 °C, and 1.000 °C documenting the influence of heat on bloodstains and the detection of blood. The results of the forensic collection of blood traces with and without liquid latex confirmed the advantage of using the latex method. Almost all objects showed a clear luminescence-caused visualization of traces of blood after removing the soot with a latex lift. There were also fewer false positive results than in tests not using latex.

Detectability, visualization, and DNA analysis of bloodstains after repainting the walls.

A recurrent observation in forensic casework is that culprits and/or their abettors attempt to remove or mask bloodstain patterns, e.g., by painting the walls. The present study was designed to elucidate whether luminol treatment of bloodstains on (a) plastered and (b) wallpapered walls may help with the visualization of respective patterns after being repainted beyond macroscopic recognition. Furthermore, wallpaper punches of luminol-positive spots were analyzed for DNA. The experiments showed that the prospects for visualization after a four- to sixfold paint application declined considerably as the drying time of the paint increased. A compelling explanation for this observation is that paint becomes increasingly resistant to water during the drying process after paint application. In these cases, moistening the surface in question with distilled water for 15 min has been proven to be a promising pretreatment before luminol application. DNA analysis revealed full STR profiles in 74% of luminol-positive wallpaper punches, whereas rubs of the aforementioned positively tested regions (luminol and human blood pretests) demonstrated negative results.

Post-mortem chemical excitability of the iris should not be used for forensic death time diagnosis.

Post-mortem chemical excitability of the iris is one of the non-temperature-based methods in forensic diagnosis of the time since death. Although several authors reported on their findings, using different measurement methods, currently used time limits are based on a single dissertation which has recently been doubted to be applicable for forensic purpose. We investigated changes in pupil-iris ratio after application of acetylcholine (n = 79) or tropicamide (n = 58) and in controls at upper and lower time limits that are suggested in the current literature, using a digital photography-based measurement method with excellent reliability. We observed "positive," "negative," and "paradox" reactions in both intervention and control conditions at all investigated post-mortem time points, suggesting spontaneous changes in pupil size to be causative for the finding. According to our observations, post-mortem chemical excitability of the iris should not be used in forensic death time estimation, as results may cause false conclusions regarding the correct time point of death and might therefore be strongly misleading.

Morphometric investigations to assess the compatibility of mandible and skull.

When a morphologically separated skull and mandible are found in the same case context, the possibility of a match arises. Two criteria with which to determine a match are the rough articulation between the mandibular condyles and cranial base itself and, most importantly, the fit of the teeth. However, when there has been intravital or postmortem tooth loss, this important criterion is not available. To date, only Reichs (1989) has investigated further compatibility criteria to solve the question of putative commingling in a case where a mandible seemed to originate from a female, while all other bones originated from a male individual. In a different reported case (Preißler et al. 2017), a mandible seemed too big for a skull; DNA analysis, however, confirmed that both originated from the same female individual. To investigate the metric relationship between mandible and skull we measured the postmortem CT data records of 223 corpses (virtual skulls) in OsiriX© MD for the following linear parameters: bicondylar breadth (KDB), biradicular breadth (AUB), and bizygomatic breadth (ZYB). The indices KDB/ZYB and KDB/AUB were developed and used to define ranges for matches and mismatches. Furthermore, the intra-observer reliability for the method was assessed. An intraclass correlation coefficient of >0.99 for every parameter showed that the used measurements are highly reliable. The 2.5-97.5 percentile for the KDB/AUB index lay between 0.91 and 1.05, while the range for the KDB/ZYB index was between 0.87 and 1.00. Within these ranges, it is possible to roughly assess whether or not a mandible and skull might be compatible, even if this can only be verified by forensic DNA analysis. If an index value lies outside these ranges, it can be assumed that skull and mandible do not match. Future studies should include more samples from a broader population spectrum so that these metric relationships can be used for different populations.

Measurement of Postmortem Pupil Size: A New Method with Excellent Reliability and Its Application to Pupil Changes in the Early Postmortem Period.

Measurement of postmortem pupil width is a potential component of death time estimation. However, no standardized measurement method has been described. We analyzed a total of 71 digital images for pupil-iris ratio using the software ImageJ. Images were analyzed three times by four different examiners. In addition, serial images from 10 cases were taken between 2 and 50 h postmortem to detect spontaneous pupil changes. Intra- and inter-rater reliability of the method was excellent (ICC > 0.95). The method is observer independent and yields consistent results, and images can be digitally stored and re-evaluated. The method seems highly eligible for forensic and scientific purposes. While statistical analysis of spontaneous pupil changes revealed a significant polynomial of quartic degree for postmortem time (p = 0.001), an obvious pattern was not detected. These results do not indicate suitability of spontaneous pupil changes for forensic death time estimation, as formerly suggested.

[Reconstructive investigations and identification measures in unknown soldiers of the Second World War]. / Rekonstruktive Untersuchungen und Identifikationsmassnahmen bei unbekannten Soldaten aus dem Zweiten Weltkrieg.

The article reports on the exhumation and identification of unknown soldiers from the Second World War. With the help of medicolegal investigation and reconstruction methods an American pilot presumably murdered by a shot to the head (lynch law) and an interned Italian soldier could be identified after about 70 years and brought back home.

Post mortem CT scans as a supplementary teaching method in gross anatomy.

Despite increasing the integration of radiologic imaging teaching in anatomy dissection courses, studies on learning outcome of these interventions are rare or have certain shortcomings in study design. In this study, students were randomly allocated to an intervention group (n=53) receiving five weekly CT-courses of 30min duration during a 6-week gross anatomy course. Students in the control group (n=329) received no additional teaching. Total teaching time did not differ among groups. All students were asked to participate in a pre- and post-course self-assessment (comparative self-assessment; CSA) of learning objectives related to anatomical spatial relationships and a post-course formative assessment on radiologic anatomy. Items of both assessments were matched. Moreover, students of the intervention group were asked to evaluate the CT-courses. Most participants of the intervention group classified the CT-courses as "good" or "very good". Nevertheless, results of the CSA and formative assessment did not differ among study and control groups. These findings indicate that the teaching intervention (CT-courses) did not have an impact on recognition of anatomical structures in radiological images beyond the knowledge acquired in the anatomical dissection course. As a consequence, interventions integrating radiology imaging into dissection courses should be based on psychological considerations of how to best foster student learning. Learning outcome has to be monitored, as results of evaluation surveys can be misleading. Further research on curricular concepts is needed considering both short- and long-term effects.

[Carbon monoxide poisoning by a heating system]. / Kohlenmonoxidvergiftungen durch Heizungsanlagen.

A case of accidental carbon monoxide poisoning in several occupants of two neighboring residential buildings in Hamburg-Harburg (Germany) caused by a defective gas central heating system is described. Because of leaks in one of the residential buildings and the directly adjacent wall of the neighboring house, the gas could spread and accumulated in both residential buildings, which resulted in a highly dangerous situation. Exposure to the toxic gas caused mild to severe intoxication in 15 persons. Three victims died still at the site of the accident. Measures to protect the occupants were taken only with a great delay. As symptoms were unspecific, it was not realized that the various alarms given by persons involved in the accident were related to the same cause. In order to take appropriate measures in time it is indispensible to recognize, assess and check potential risks, which can be done by using carbon monoxide warning devices and performing immediate COHb measurements with special pulse oximeters on site. Moreover, the COHb content in the blood should be routinely determined in all patients admitted to an emergency department with unspecific symptoms.

[Human frontal inclination of the skull as a trait of sexual dimorphism--terminology and quantification]. / Die Stirnneigung am knöchernen Schädel als Geschlechtsdiskriminierungsmerkmal--Begriffsdefinition und Quantifizierung.

The skull presents a variety of morphological traits suitable for sex discrimination due to the degree of their development. The vertical frontal inclination has been established. as another marker of sex discrimination, as a steep forehead is considered as a female and a receding frontal inclination as a male attribute. In the literature, there are many different ways to define the morphognostic term "frontal inclination" and "forehead profile" respectively. As part of the project "Digital Forensic Osteology" definitions of the frontal inclination commonly found in the literature have been tested with regard to their applicability to virtual skulls based on post-mortem CT data. The actual angle measurements were carried out automatically using software developed by the authors of this article. For the investigations, profile images of skulls generated from volume-rendered CT data were used in which anthropometric measuring points had been set manually. With the help of discriminant analysis it was tested whether sex discrimination on virtual skulls based on defined variables can be carried out with sufficient sensitivity. The measurement accuracy of the defined variables on the volume-rendered images turned out to be good. No significant sex differences regarding the tested variables were found. Using all the four selected variables the sensitivity for female skulls was only about 66%, whereas for male skulls it was not much higher than the rate of coincidence (53%). The results of this pilot study suggest that apart from extending the sample size the inclusion of additional variables based on strict consideration of validity and reliability criteria should be critically tested.

[Obesity--comorbidities and causes of death]. / Adipositas: Folgekrankheiten und Todesursachen--eine rechtsmedizinische Betrachtung.

53% of the forensically autopsied decedents in Hamburg were overweight. The cause of death and any comorbidities, especially coronary heart disease, are often associated with the obese condition. This correlation is illustrated by two examples, viz. a 65- and a 56-year-old man with grade III obesity, which do not only show the medical but also the logistical problems that come along with it.

Molecular identification of fungi found on decomposed human bodies in forensic autopsy cases.

To investigate which fungi can be found during forensic autopsies, a PubMed literature review was done in regard to fungal growth on decomposed human bodies. Unfortunately, the existing data is limited and not all fungi were identified to the species level. We, therefore, collected skin samples with macroscopically visible fungal growth from 23 autopsy cases in Germany and identified the fungi to the species level by molecular methods. The identified species included Aspergillus fumigatus and Candida albicans, which pose an allergenic risk, especially to persons with underlying lung diseases. Because safety standards are lacking, we recommend the use of respiratory protection during exhumations and forensic autopsies, when fungal growth is noted. With regard to the future, a database was set up which could possibly be used as a forensic tool to determine the time of death.

[Suicide among physicians--a current analysis for the City of Hamburg]. / Suizide von Ärztinnen und Ärzten--eine aktuelle Analyse für Hamburg.

According to the literature, physicians have an increased risk of committing suicide, which can partly be explained by occupational stress. A retrospective analysis of the deaths investigated by the Hamburg office of Criminal Investigation and documents of the Hamburg Institute of Forensic Medicine for the years 2001 to 2013 showed that the average suicide rate among physicians is not significantly higher than that of the total population, it is 0.021% for physicians, 0.023% for dentists and 0.013% for the general public; thus the difference is not statistically significant (p: 0.57 for physicians and 0.74 for dentists). Drug intoxication has been found to be the most common method of suicide committed by physicians. However, these results must be interpreted with caution in view of the fact that a detailed evaluation of data was often not possible, especially because information as to the profession of the deceased and the motive for the suicide were missing or insufficiently documented.

Morphology as a cause for different classification of the ossification stage of the medial clavicular epiphysis by ultrasound, computed tomography, and macroscopy.

The assessment of the ossification status of the medial clavicular epiphysis plays a decisive role in forensic age diagnostics to determine whether a person has completed his or her 18th or, respectively, 21st year of life. Currently, computed tomography is the gold standard method for age diagnostics of this kind. However, efforts are being made to establish non-ionizing methods, such as ultrasonography, predominantly, in an attempt to reduce the radiation exposure load of living persons. The present study is the first to score and to compare the ossification status of both medial clavicular epiphyses of the same subjects by sonography, computed tomography, and, in some of the cases, by macroscopy. Our study was conducted on five male corpses, ranging in age from 15.8-28.8 years. In the comparison of high-resolution sonography (frequency, 12-15 MHz) and thin slice computed tomography (slice thickness, 0.6 mm), performed separately for left and right clavicles, the results from these two methods differed in seven of ten cases. In six cases, the ossification stage of the medial clavicle, determined by sonography and classified according to Schulz et al. (2008), was scored higher than with computed tomography. In one case, it was rated lower. There was only one subject for whom both the sonographic and computed tomography findings agreed for both body sides.

Foudroyant Course of an Extensive Clostridium septicum Gas Gangrene in a Diabetic Patient with Occult Carcinoma of the Colon.

Background. Spontaneous gas gangrene is a rare disease in which Clostridium septicum frequently can be detected. After an incubation period of 5-48 hours, a very painful swelling is accompanied by a rapidly spreading toxic-infectious clinical picture ultimately leading to septic shock and multiple organ failure. We present a case of a completely documented rare infectious disease with triage findings including initial vital signs, initial medical findings, and the emergency lab., radiological, intraoperative, histopathological, microbiological, and postmortem results. After initial diagnosis of the underlying disease, the patient has been immediately transferred to the operating theatre. The laboratory findings reflect the devastating effect of toxin α which is a toxin typically produced by C. septicum. The patient presented both an anaemia and a manifest coagulopathy as well as an onset of multiple organ failure. Despite the aggressive medical and surgical measures that have been taken, this patient could not be saved. Discussion. The case presented vividly emphasises the difficulty to identify these cases early enough to save a patient. This documentation may help health care providers to identify this life threatening disease as early as possible in future cases.

Estimation of the time since death--reconsidering the re-establishment of rigor mortis.

In forensic medicine, there is an undefined data background for the phenomenon of re-establishment of rigor mortis after mechanical loosening, a method used in establishing time since death in forensic casework that is thought to occur up to 8 h post-mortem. Nevertheless, the method is widely described in textbooks on forensic medicine. We examined 314 joints (elbow and knee) of 79 deceased at defined time points up to 21 h post-mortem (hpm). Data were analysed using a random intercept model. Here, we show that re-establishment occurred in 38.5% of joints at 7.5 to 19 hpm. Therefore, the maximum time span for the re-establishment of rigor mortis appears to be 2.5-fold longer than thought so far. These findings have major impact on the estimation of time since death in forensic casework.

Post-mortem computed tomography (PMCT) and PMCT-angiography after transvascular cardiac interventions.

BACKGROUND AND PURPOSE: During the last years, Post Mortem Computed Tomography (PMCT) has become an integral part of the autopsy. PMCT-angiography may augment PMCT. Both exams have proven their value in visualizing complications after heart surgery. Therefore, they should also show complications after transvascular interventions. This assumption initiated our project: to evaluate the possibilities of PMCT and PMCT-angiography after transvascular cardiac interventions. MATERIAL AND METHODS: In our archives of characteristic and typical PMCT findings, we searched for observations on preceding transvascular cardiac interventions. Additionally, we reviewed our PMCT-angiographies (N = 140). RESULTS: After transvascular cardiac interventions, PMCT and PMCT-angiography visualized bleeding, its amount and its origin, cardiac tamponade, free and covered perforations, transvascular implanted valves and their position, catheters and pacemakers with fractures, abnormal loops and bending. Bubbles in the coronary vessels (indicating air embolism) become visible. CONCLUSION: After transvascular cardiac interventions, PMCT and PMCT-angiography show complications and causes of death. They prove a correct interventional approach and also guide autopsy. In isolated cases, they may even replace autopsy.

Post-mortem development of conjunctival petechiae following temporary prone position.

Conjunctival petechiae are an important diagnostic finding in external examination of forensic cases, being a sign of possible mechanical compression of the neck and jugular veins (e.g. choking, strangulation). Nevertheless, it is well known, that strong congestion of the conjunctival blood vessels might lead to the development of petechiae in the perimortal and early post mortem period, e.g. due to a head down position of the body. By now it remains unclear, whether a short term horizontal prone position of a body can lead to the development of conjunctival petechiae in the early post mortem period, a situation that might occur in everyday forensic casework. Therefore, we investigated the occurrence of conjunctival petechiae in 20 deceased at <12 h after death following a prone position of 2 h. Petechiae developed in 8 cases. Therefore, our results for the first time give evidence that conjunctival petechiae can be observed after a short-term horizontal prone position of a body in the early post mortem period, influencing the assessment of future forensic cases. Furthermore, statistical analysis revealed significant correlations with the examination method used to ectropionise the eyelids (forceps vs. cotton swab) and preceding resuscitation attempts. The latter observations should be considered in future research on the phenomenon.