Intoxications involving methoxyacetylfentanyl and U-47700: a study of 3 polydrug fatalities.

Novel synthetic opioids (NSOs) represent an emerging group of novel psychoactive substances, acting as agonists at the opioid receptors. NSOs include fentanyl-related compounds, e.g. methoxyacetylfentanyl (MeACF), and non-fentanyl analogs, e.g. "U compounds" including U-47700. Here we present three cases of death involving MeACF and U-47700, with particular reference to preliminary data on pharmacokinetics and tissue distribution.After a complete post-mortem examination, general unknown screenings and analysis of drugs of abuse were performed on postmortem samples by immunoassays, gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry. To quantify the analytes of interest in post-mortem blood and tissues, the standard addition method was used. A toxicological significance score (TSS), weighing the role of the NSO in each death case, was assigned.Case 1 died at the hospital after consumption of U-47700, methadone (serum levels: 2,600 ng/ml and 37 ng/ml), tilidine and benzodiazepines. In case 2, U-47700 (204 ng/ml) together with methadone (290 ng/ml), flubromazepam (480 ng/ml) and diazepam (300 ng/ml) were detected in peripheral blood. In case 3, methoxyacetylfentanyl (266 ng/ml), furanylfentanyl (4.3 ng/ml) 4-ANPP (15 ng/ml) and alprazolam (69 ng/ml) were quantified in femoral blood. In all cases, the NSO likely contributed to the death (TSS = 3).NSOs appear to be often consumed in the setting of polydrug intoxications, especially in combination with other opioids and benzodiazepines, which often exert synergistic effects. The standard addition method remains the most reliable in post-mortem analysis and toxicological results should always be evaluated together with circumstantial and autopsy data.

The punched-out tissue complex (skin-bone "imprimatum") in shots from captive-bolt guns: does it act as a secondary projectile?

From the first half of the twentieth century to the present day, injuries and fatalities from captive-bolt livestock stunners are a major topic in forensic medicine. The vast majority of cases account for suicides with the frontal, temporal, parietal, and occipital regions being the most common sites of entrance (in descending order of frequency). Due to the limited length of the bolt, the corresponding wound channel within the braincase is only several centimeters long. It has been a controversial subject for a long time, whether the skin-bone complex punched out by the conically grooved end of the steel rod may act as a "secondary projectile" being propelled beyond the actual path of the bolt. To answer this question, experimental shots from various types of captive bolt-guns were fired to simulants. Video-documentation employing a high-speed motion camera showed that the punched-out pieces of skin and bone did not move further than the bolt. Thus, a secondary extension of the total wound channel could not be observed. However, the suction effect caused by the bolt's rearward movement may induce a slight retrograde displacement of the skin-bone complex.

Bullet wipe on the uppermost textile layer of gunshot entrance sites: may it be absent due to pre-existing blood staining?

Most gunshot entrance sites on human victims are localized in clothed body regions. Except for the use of lead-free ammunition, a positive color reaction of the sodium rhodizonate test indicates a primary target hit by the bullet. Any lead residue pattern in the area around the entrance hole allows approximate conclusions as to the firing distance in close and intermediate range shots, whereas the presence of a bullet wipe denotes an entrance site. A criminal case gave rise to an experimental study to clarify whether a blood-soaked garment being shot at as a primary target may lack a bullet wipe around the entrance hole. Distant-range shots were fired with a semi-automatic pistol (Heckler & Koch, Mod. USP Compact, cal. 9-mm Luger) using cartridges with jacketed round-nose bullets and a Sinoxid primer containing lead styphnate. In fabrics saturated with fluid blood, a wide area around the bullet entrance was densely covered with rhodizonate-positive microparticles simulating gunshot residues (GSR) from a close-range shot. In shots to fabrics oversaturated with blood, a typical bullet wipe was lacking, whereas lead-containing particles were spotted in the periphery. The results are discussed with respect to the aberrant appearance of bullet entrance sites in blood-soaked fabrics.

Rearward movement of the slide in semi-automatic pistols: a factor potentially influencing the configuration of muzzle imprint marks in contact shots.

A muzzle imprint mark is a highly diagnostic finding, which indicates a contact shot. In many cases, it also provides additional information on the type of the weapon used and on the way in which it was held at the time of firing. In semi-automatic pistols, some constructional elements constituting the muzzle plane move to the rear together with the slide, which may prevent them from causing a corresponding imprint close to the bullet entrance hole. The present study comprises 30 consecutive autopsy cases of fatal contact shots to the head inflicted with semi-automatic pistols. The imprint marks accompanying the entrance wounds were compared with the muzzle ends of the respective weapons both before and after retracting the slide. It turned out that in a considerable number of cases (3 out of 30), the retractable parts were not depicted or only to a minor degree as components of the imprint mark. In order to validate the presumed correlation, experimental shots were fired to composite models using pistols in which the movable and the stationary parts forming the muzzle plane were dyed with different paints. Thus, it could be demonstrated that the muzzle imprint preferentially mirrors the front sides of the stationary parts such as the barrel end, the recoil guide, and the gun housing. Immediately after discharge, the slide and the ballooning skin of the bullet entrance site move in the same direction. The stationary parts of the weapon block the expansion of the skin bulging towards the muzzle, so that the skin gets firmly pressed against them. The dynamic interaction between the gun and the entrance region resulting in a characteristic imprint mark could be visualized by the use of a high-speed motion camera recording test shots to different composite models.

Wound morphology in contact shots from blank cartridge handguns: a study on composite models.

It is a well-known fact that blank cartridge guns can cause penetrating and even fatal injuries when discharged in contact or at very close ranges. In these cases, the gas jet perforates the skin leaving an entrance wound similar to that from a conventional gun. In order to investigate the wound morphology in contact shots from blank firearms, test shots were fired at composite models of pig skin and gelatin blocks using three different calibre 9-mm blank cartridge handguns (two pistols and one revolver) and two types of ammunition. It turned out that the penetrating gas jet produced roundish skin defects resembling bullet entrance holes. Small skin particles from the perforation site were dispersed in the underlying simulant where radiating cracks containing greyish gunshot residues indicated the original expansion of the inrushing combustion gases. Apart from the size of the permanent entrance hole in the skin and the final position of the displaced tissue particles, the penetration depth of the gas jet was determined. Under the specified conditions of the test shots, the zone of mechanical destruction within the simulant was 2.2 to 6.1 cm in length, which illustrates the injuring potential of contact shots inflicted with blank cartridge handguns.

Suicide with two makes of captive-bolt guns (livestock stunners) fired simultaneously to the forehead.

In humans, most fatalities from slaughterer's guns are suicides committed by persons familiar with stunning devices. The great majority of cases accounts for shots to the head, especially the frontal region. Only a small number of two subsequent cranial shots from captive-bolt humane killers have been reported up to now. In the case presented by the authors, a suicide by simultaneous shots to the head fired from two different makes of captive-bolt guns (one of them having two separate outlets for the combustion gases in the muzzle plane, the other type having no additional openings) is described for the first time. One of the shooting devices remained in firm contact with the left hand and produced patterned staining from rust corresponding to the surface relief of the gun. The medicolegal and criminalistic aspects of this unique case are discussed with reference to the pertinent literature.

The influence of the bullet shape on the width of abrasion collars and the size of gunshot entrance holes.

To investigate if there is any correlation between the bullet design and the respective dimensions of the abrasion collar and the skin defect in gunshot entrance wounds, experimental studies were performed on dyed pig skin. For the test shots, .38 Special revolver cartridges with three different bullet designs (round nose, wadcutter, and truncated cone) were used. With the help of an image editing program in combination with an image analyzing system, the area size of the abrasion rings and the skin defects was calculated automatically. The measured values differed significantly depending on the bullet type: the abrasion ring areas were largest in shots with round nose bullets and smallest with wadcutter projectiles. With regard to the entrance hole size, the relationship was inverse. The results are discussed with reference to the pertinent literature concerning the dynamic interaction between bullet and skin.

Pseudo-tying injuries in a hanged person.

A 50-year-old man was found hanged on the concrete dam of a water reservoir. The ligature, a braided rope made of synthetic fibres, was attached to a lamp on the dam crest. The length of the rope between the fastening point and the noose was about 4m. At autopsy, stretchmark-like intimal tears of the carotid arteries were found, but the full pattern of (internal) decapitation and severance of the cervical spine was not present. The right wrist showed two almost circular, ribbon-like abrasions initially suggesting that the man had been tied before hanging. When the ligature was examined, horny scales adhered to the noose, but were also detected away from the slip-knot. By means of a DNA analysis the epidermal traces could be assigned to the deceased. The overall picture of the findings suggested that the man had roped down from the dam crest with the ligature wrapped around his right wrist thus abrading the skin.

A patterned abrasion caused by the impact of a cartridge case may simulate an atypical muzzle imprint mark.

In contact shots, the muzzle imprint is an informative finding associated with the entrance wound. It typically mirrors the constructional components being in line with the muzzle or just behind. Under special conditions, other patterned skin marks located near a gunshot entrance wound may give the impression to be part of the muzzle imprint. A potential mechanism causing a patterned pressure abrasion in close proximity to the bullet entrance site is demonstrated on the basis of a suicidal shot to the temple. The skin lesion in question appeared as a ring-shaped excoriation with a diameter corresponding to that of the cartridge case. Two hypotheses concerning the causative mechanism were investigated by test shots: - After being ejected, the cartridge case ricocheted inside a confined space (car cabin in the particular case) and secondarily hit the skin near the gunshot entrance wound. - The ejection of the cartridge case failed so that the case became stuck in the ejection port and its mouth contacted the skin when the body collapsed after being hit.

[Fire disaster due to deflagration of a propane gas-air mixture]. / Folgenschwerer Brand durch Entzündung eines Propangas-Luft-Gemisches.

On 26 Nov 2012, a serious fire occurred at Neustadt/Black Forest in which 14 persons in a sheltered workshop died and 10 other individuals were injured. The fire was caused by the unbridled escape of propane gas due to accidental disconnection of the screw fixing between a gas bottle and a catalytic heater. Deflagration of the propane gas-air mixture set the workshop facilities on fire. In spite of partly extensive burns the fatally injured victims could be rapidly identified. The results of the fire investigations at the scene and the autopsy findings are presented. Carboxyhemoglobin concentrations ranged between 8 and 56 % and signs of fire fume inhalation were present in all cases. Three victims had eardrum ruptures due to the sudden increase in air pressure during the deflagration.

[Death by avalanche in the minor mountain range]. / Lawinentod im Mittelgebirge.

On 30 Jan 2015, two avalanche accidents happened in the Black Forest (at the foot of the 1493 m high Feldberg and the Herzogenhorn situated next to it), in which experienced ski tourers--a 58-year-old woman and a 20-year-old man--were completely buried by snow masses. Both victims were recovered dead after nearly 2 hours under the snow. The avalanches were promoted by strong snowfalls, snowdrift by the wind and steep downwind slopes. One of the victims, the 20-year-old man, underwent a forensic autopsy. The findings suggested death by protracted asphyxiation with agonal hypothermia. A mechanical traumatization with internal injuries suspected by the emergency doctor at the scene could not be confirmed at autopsy. The possible causes of death in the avalanche are discussed using the reported case as an example and in reference to the relevant literature.

Fatal contact shot to the chest caused by the gas jet from a muzzle-loading pistol discharging only black powder and no bullet: case study and experimental simulation of the wounding effect.

In modern medico-legal literature, only a small number of publications deal with fatal injuries from black powder guns. Most of them focus on the morphological features such as intense soot soiling, blast tattooing and burn effects in close-range shots or describe the wound ballistics of spherical lead bullets. Another kind of "unusual" and potentially lethal weapons are handguns destined for firing only blank cartridges such as starter and alarm pistols. The dangerousness of these guns is restricted to very close and contact range shots and results from the gas jet produced by the deflagration of the propellant. The present paper reports on a suicide committed with a muzzle-loading percussion pistol cal. 45. An unusually large stellate entrance wound was located in the precordial region, accompanied by an imprint mark from the ramrod and a faint greenish discoloration (apparently due to the formation of sulfhemoglobin). Autopsy revealed an oversized powder cavity, multiple fractures of the anterior thoracic wall as well as ruptures of the heart, the aorta, the left hepatic lobe and the diaphragm. In total, the zone of mechanical destruction had a diameter of approx. 15 cm. As there was no exit wound and no bullet lodged in the body, the injury was caused exclusively by the inrushing combustion gases of the propellant (black powder) comparable with the gas jet of a blank cartridge gun. In contact shots to ballistic gelatine using the suicide's pistol loaded with black powder but no projectile, the formation of a nearly spherical cavity could be demonstrated by means of a high-speed camera. The extent of the temporary cavity after firing with 5 g of black powder roughly corresponded to the zone of destruction found in the suicide's body.

The varying size of exit wounds from center-fire rifles as a consequence of the temporary cavity.

To study the question whether and how the size and position of the temporary cavity influence the morphology and especially the size of a bullet exit wound, test shots were fired to composite models consisting of gelatine and pig soft tissue covered with skin (at the exit site). The dimensions of the composite model were determined such that the exit planes were located either at the level of the narrow channel or within the temporary cavity or behind it. The chronological sequence of wound formation and its relation to the current position of the bullet were documented by means of a high-speed camera. Test shots were fired from a distance of 10 m using 5.56 × 45 mm cartridges with full metal-jacketed pointed bullets (v 0 ∼ 912 m/s, E 0 ∼ 1,663 J). The study proved that the extension and position of the temporary wound cavity was decisive for the size of the exit wound: An exit plane within the cavity resulted in particularly large skin lesions, whereas the wound diameters were much smaller if the exit plane was located in front or behind the cavity. The exit hole reaches its maximum size only after the bullet has left the target synchronous to the staggered expansion of the temporary cavity.

Primarily unrecognized thoracoabdominal impalement in a motorcyclist.

In traffic accidents, fatal impalements are mostly seen in vehicle occupants injured by penetrating blunt-tipped objects such as fence posts or iron bars. Compared with this group of road users, the medical literature lacks reports on impaled motorcyclists. The article presents a case which deserves attention in several respects: 1. Both the impaling object and the victim were moving at the moment of penetration. 2. The lethal impalement trauma remained unrecognized until autopsy, particularly since the causative object did not get stuck in the wound track. 3. Two different body parts (head and trunk) were consecutively affected analogous to re-entry wounds in gunshots and stabs. 4. Due to the tubular shape and the sharp-edged end of the penetrating instrument (stanchion of a broken front-wheel's fork), clothing and soft tissues were punched out along the wound channel and partly remained lodged in the tube's cavity.

Modification of hematoma findings in the breast region.

Subcutaneous bruises caused by blunt injury are common findings in medicolegal case work. If the hematoma involves the anterior thoracic wall, bruises are mostly absent in the region of the nipples and the surrounding areola. A similar phenomenon has already been described for hypostatic skin hemorrhages. A possible explanation for both phenomena is the special tissue texture in the nipple-areola complex. Based on four cases from the forensic autopsy material and two cases from clinical forensic examinations, the macromorphological findings and the histological correlates are presented.