Pathological changes of the heart in sudden infant death.

There are more than 120 different theories on the possible causes of sudden infant death (SID). In particular, dysfunctions of the central nervous system, cardiorespiratory insufficiency due to infections including atypical immune reactions, and cardiac dysregulation have been discussed during the previous decade. Reports on disturbances of the cardiac rhythmogenic function due to LQTS were among the most speculative. Based on gross histological, immunohistochemical and molecular genetic investigations of SID cases, the most important and most frequent findings of the heart are shown. The significance of different types of myocarditis, hypoxia-related changes, disturbances of the rhythmogenic function, cardiomyopathy, and other changes is discussed with regard to the cause of death. In conclusion, most of the changes reported in the literature are not sufficient to explain the cause of death. Problems in the diagnosis are shown which influence the classification of these disturbances as well as the classification of SID.

Fatal malignant hyperthermia--delayed onset and atypical course.

A case of malignant hyperthermia (mh) in a 27-year-old man is described. In a first anaesthesia using isoflurane and succinylcholine, the end-tidal CO(2) rose from 39 to 49 mmHg 2.75 h post-intubation and the body temperature rose to 39.8 degrees C 14 h post-intubation but was normal again the next day. In a second anaesthesia using the same medication, the maximal end-tidal CO(2) was 44 mmHg and the body temperature rose to 39 degrees C after 9 h. After 4 days, the fever rose to 40 degrees C, and to 42 degrees C when death occurred 10 days after the second anaesthesia. Masseter spasms or muscle rigidity were never present. According to the death certificate, death was due to multi-organ failure from sepsis. At autopsy, the skeletal muscles were pale and oedematous. Histology demonstrated focal necroses in the skeletal muscles, shock kidneys with myoglobin excretion and myoglobin clots in small blood vessels of the lungs. Hence, the postmortem diagnosis "malignant hyperthermia" was established but accusations of medical maltreatment were rejected because of the atypical and protracted clinical course and because uncharacteristic signs of malignant hyperthermia were attributable to the clinically suspected sepsis.

Was the pedestrian hit in an erect position before being run over?

If a pedestrian was run over by a car, the question can arise whether there was a preceding collision while the pedestrian was in an erect position. From a total of 53 selected autopsy reports, the findings associated with accidents known to involve running over in isolation (n=32) were compared to findings associated with a combined mechanism of a primary impact in an erect position and subsequent running over (n=21). Findings exclusively present in the combined group were wedge-shaped bone fractures ("Messerer"-wedges, 38%), glass fragment injuries (24%), traumatic amputations (10%), traces of car paint on the lower extremities (50%) and abrasions of the shoe soles (17%). These findings can be considered specific for a primary impact in an erect position. Fractures of the cervical and lumbar spine were present in the combined group in 33 and 17%, respectively. In contrast, in the run over group, there was only one case of fracture of the cervical and one of the lumbar spine and both cases involved direct contact with a car wheel. Fractures of the cervical and lumbar spine are, therefore, very indicative for a primary impact. "Bumper injuries", sacroiliac dislocations and fractures of the thoracic spine were approximately 2.5 times more common in the combined group than in the run over group. In the vast majority of cases, a clear differentiation between the two groups is, therefore, possible on the basis of the autopsy findings. This is especially relevant if an inspection of the car cannot be performed after a hit-and-run accident, which occurred in 26% of the cases in this study. In addition, the blood alcohol levels were higher in the run over group (mean=2.14g/l) as compared to the combined group (mean=1.53g/l).

Post-mortem orthopantomography--an aid in screening for identification purposes.

Ante-mortem orthopantomograms may be of great value in the identification of human remains. This x-ray technique provides an overall view of the teeth and jaws and thus of numerous individual structural characteristics within a short time. Standardised post-mortem orthopantomography has previously not been feasible in the forensic practice. The present study shows how orthopantomography can be applied to identification procedures. The reproduction of ante-mortem x-ray conditions is implemented here in the production of post-mortem x-rays, using a purpose-designed radiographic tripod. For the first time, account is taken not only of the size and structure but also of the nature of the soft tissue covering of exhibits. For post-mortem preparation of these radiographs, appropriate positioning aids, a spinal column substitute and a soft tissue filter were constructed. Individual macerated jaws as well as the complete cranium can now be positioned correctly in the upright orthopantomograph (OPG). The method presented expands the spectrum of forensic radiology for the individual case and in our opinion also offers a reliable aid for victim identification in the wake of mass disasters, aircraft crashes and terrorist attacks, where a large number of bodies have to be identified under great pressure.

Relationship between impact velocity and injuries in fatal pedestrian-car collisions.

The most common type of fatal pedestrian-car collision, i.e. a passenger car with a wedge or pontoon shaped front striking an erect adult with this front, was investigated. A reliable calculation of the impact velocity range by a technical expert and a comprehensive autopsy suitable for traffic accidents were performed in every case. A total of 47 fatalities form the material of this study and the impact velocities varied between 18 and 142 km/h. Primary and secondary injuries did not show a relationship to impact velocity. The occurrence of four types of indirect injuries revealed a clear relationship to impact velocity, i.e. spinal fractures, ruptures of the thoracic aorta, inguinal skin ruptures and dismemberment of the body. Important parameters such as the type of car, impact velocity range and indirect injuries are listed for each individual case. Because of the limited number of cases, the impact velocity ranges (3-30 km/h) instead of mean values were considered. A cautious interpretation of the data can be summarised in the following conclusions: If there is no spinal fracture, the velocity was below 70 km/h and probably below 50 km/h. Aortic and inguinal skin ruptures are always present if the velocity was above 100 km/h but never occurred below 50-60 km/h. If dismemberment occurs, the velocity was above 90 km/h. Consequently, an estimation of the impact velocity from the presence or absence of indirect injuries is possible in pedestrian-car collisions of the type examined. However, the selection criteria applied in this study and additional parameters influencing the collision dynamics have to be considered carefully.

Morphological findings in the brain after experimental gunshots using radiology, pathology and histology.

The tissue disruption inside the brain after experimental gunshots to the head was investigated with special reference to secondary bone missiles and intracranial pressure effects such as cortical contusion and deep intracerebral haemorrhages. The evidential value of various examination methods is compared. 9 mm Parabellum ammunition was fired to the temporal region of calves (n = 10) from a distance of 0-10 cm. Plain film radiography, CT, MRI, visual inspection and histology were performed on every brain. The tissue disruption of the permanent tract is delineated best by artefact-free MRI. Cortical contusions and deep intracerebral haemorrhages were detected infrequently by visual inspection and imaging techniques although they were present in every brain as verified by histology. These injuries remote from the tract increase cerebral wounding compared to non-confined tissue. In particular, the brain stem and central areas were frequent sites of haemorrhages, which can be expected to have serious and immediate consequences. Ectopic bone fragments were found in all brains using CT scans. Bone fragments were located inside clearly enlarged permanent tracts or were driven into brain tissue. In the latter cases, secondary shot channels up to 4 cm in length could be verified by histology. Cortical contusions and intracerebral haemorrhages can only be detected reliably by histology. The localization of bone fragments requires CT scans. Therefore, a detailed examination is accomplished best by a combination of the methods applied in this study.

[Is identification of badly burned cadavers impossible? Reconstruction of the burned facial skull as a basis for roentgen identification]. / Ist die Identifikation stark verbrannter Leichen aussichtslos? Rekonstruktion des verbrannten Gesichtsschädels als Basis für die Röntgenidentifikation.

The described case underlines all difficulties which arise in identification procedure of totally burned human remains. The main problem is the fragility of bone and tooth fragments and the radiological screening of structures of high individual specificity. After the fire in an old beekeeping a totally burned corpse has been found. The fragments of the bones and jaws were fixed with sodium silicate immediately. The viscero-cranium was reconstructed and x-rayed in an modified orthopantomography-x-ray-equipment. The comparison of pre- and postmortem radiographs made a positive identification possible.

Fatalities from black powder percussion handguns.

Three suicides and one homicide from black powder muzzle loading handguns are reported and the muzzle velocities of two weapons are recorded. The fatal head shots caused wide wound tracts traversing the brains and intracerebral haemorrhages remote from the tract were present in every case. The skulls showed considerable fractures which were pronounced in the cases of contact shots but were also present when the range of fire was 5 m. These extensive injuries from soft lead spheres with muzzle velocities of only approximately 200 m/s are attributed to the expansion of the spheres. The regularly occurring deformation resulted in 13-16 mm calibre missiles in the cases of .44 spheres. The special features of black powder such as incomplete and slow combustion resulted in intense soot deposits in the vicinity of the entrance wound and in long ranges the gunshot residues travelled. In contact shots, large pocket-like underminings even in deeper tissue layers, abundant soot along the trajectory and skin burns were observed.

Laceration of the thoracic aorta from a .22 lr bullet.

A gunshot wound (.22 long rifle) to the chest including perforation of the aorta ascendens is presented. The small wound tract in soft tissue was characteristic for this type of ammunition and did not show any special peculiarities. However, arterial injury was not restricted to two small perforations, as expected in the light of previous wound ballistic findings. Three large longitudinal ruptures (3.0-4.5 cm in length and two of them independent of the perforations) additionally occurred, which led to rapid exsanguination. This extraordinary extent of vascular injury can be explained by perforation of the artery during the ventricular ejection phase, which causes a considerable dilation of the aorta analogous to a windkessel. The pre-existing dilation enables intraluminal temporary cavitation to have an "explosive" effect despite the high elastic tolerance to the vessel wall. The importance of tissue characteristics in gunshot wounds in general and the possible role of temporary cavitation inside the vessel in vascular gunshot wound production in particular are stressed.

[Suicide with a nail gun device: wound ballistics and wound entry morphology]. / Suizid mit einem Bolzensetzwerkzeug: Wundballistik und Einschussmorphologie.

A man committed suicide by a contact shot to the left chest from a nail-gun. The nail caused a slit-like entrance wound and a penetrating heart injury. The front side of the nailgun led to an outer "muzzle imprint", the muzzle and the nail to an inner "muzzle imprint". Wound ballistics of nails are discussed.

[2 suicides with self-fabricated gunshot devices: technical forensic and morphologic ballistic characteristics]. / Zwei Suizide mit selbstgefertigten Schussapparaten: Kriminaltechnische und einschussmorphologische Besonderheiten.

Two suicides with home-made guns firing conventional ammunition are reported. Three different classes of homemade guns can be distinguished. Special characteristics of the interior and exterior ballistics of the home-made guns caused unusual muzzle imprints, intensive soot deposits at the entrance wounds and on the hands, intensive CO-effects, burns and in one case a skin laceration of the hand holding the weapon. The bullets showed a reduced penetration depth, characteristic firing marks were missing.

[Presentation of fingerprints of cadavers after an extended period of time, and also immersed cadavers]. / Darstellung der Fingerabdrücke bei länger liegenden Leichen, u.a. Wasserleichen.

Dactyloscopic fingerprints of longer time in water laying corpses can be taken from the surface and rear face of the epidermis and from the corium with a simple method. Used are in household occurring or easily available substances. For best results in identification it is important to get all fingerprints without exchanging them.

[Distribution of textile fibers in the path of a bullet]. / Die Verteilung textiler Fasern im Schusskanal.

Twenty-one blocks consisting of 20% gelatin were fired at using firearms of the long rifle caliber .22 and .357 Magnum. The frontal area of these blocks was prepared with textile coverings marked with technetium 99m. Two gunshot series of each type were fired at summer, interseasonal, and winter clothing, using different ammunition. The radioactivity of the bombarded blocks was measured by single photon emission computed tomography (SPECT). The results of these gun shot series were presented graphically and compared. Initially (at 2 cm depth), high radioactivity is always detected, which among other things is caused by the defilement of the bullet's surface when shot through the textile covering marked by technetium. The higher radioactivity in the middle and deeper block areas is the result of fiber infiltration. Accordingly, there are greater fiber accumulations in the middle and deeper areas of the path of the bullet. This is the case mainly in thinner clothing (summer). Heavier clothing (autumn, winter) presents a greater obstacle for bullets with greater impact as well. Here, only projectiles having a lesser tendency to deform, as well as a high impact, transport a considerable proportion of textile fibers into the deeper parts of the blocks.

[Reconstruction of the sitting position in automobiles by microtrace analysis]. / Die Rekonstruktion der Sitzposition durch Mikrospurenanalyse.

Three car accidents are described in which microtrace analysis was of special significance in the clarification of the seating positions. In all three cases the occupants were under the influence of alcohol. In each case the accident occurred at night and without witnesses. The pattern of injuries in two cases was non-specific. In the first case, no fiber traces were visible to the naked eye; in the other two the fibers were recognizable to the naked eye after close examination. In all three cases, the seating position was ascertained by means of fiber trace analysis.

[Morphometric studies of x-rays of the sternum]. / Morphometrische Untersuchungen am Röntgenbild des Brustbeines.

Sex determination of a sufficient certainty is possible using measurements (length and breadth) obtained by X-rays of the human sternum. Body height may be determined by X-rays of the human sternum if a wide dispersion is given. The given relations and formulae are valid only when measuring the sterna of adults.

[Electronographic representation of finger prints on the skin of cadavers]. / Elektronographische Darstellung von Fingerabdrücken an Leichenhaut.

Taking electronographs from fingerprints is a technique with expense and circumstantiality. Moreover this technique yields bad results when finger-prints were taken from the skin of dead persons.

[The diffusion of ethanol from blood into intestine: rates of transport (author's transl)]. / Die Geschwindigkeitskonstanten der Athanoldiffusion an der Blut-Darmschranke.

Measurements of the ethanol flow from the blood into the gastrointestinal tract revealed an exponential characteristic. The rates of transport were proportional to the differences in concentration. The constants of the exsorption were equal to those of the insorption. The constants of the exsorption were 0.033 min-1 for the stomach, 0.071 min-1 for the small, and 0.019 min-1 for the large intestine.