Fatal aviation accidents in Lower Saxony from 1979 to 1996.

So far no national or regional studies have been published in Germany regarding the number of fatal aviation accidents and results of autopsy findings. Therefore, we evaluated all fatal aviation accidents occurring in Lower Saxony from 1979 to 1996. A total of 96 aviation accidents occurred in this period involving 73 aeroplanes. The crashes resulted in the death of 154 people ranging in age from 19 to 68 years. The greatest number of victims in a single crash of an aircraft was (n=7). Other types of fatal accidents were crashes of aircraft and helicopter while on the ground (n=5), hot-air balloons (n=2), parachutes (n=10), hang glider accidents (n=5) and the striking of a bystander by a model airplane. Autopsies were performed on 68 of the 154 victims (44.2%), including 39 of the 73 pilots (53.4%). Some of the autopsies yielded findings relevant to the cause of the accident: gunshot wounds, the presence of alcohol or drugs in blood and preexisting diseases. Our findings emphasize the need for autopsy on all aviation accident victims, especially pilots, as this is the only reliable method to uncover all factors contributing to an accident.

[Criminal and suicidal death with bolt gunshot weapons. An experimental and case contribution]. / Kriminelle und suizidale Tötungen mit Bolzenschussgeräten. Ein experimenteller und kasuistischer Beitrag.

Authors report on two cases of homicide and another case of suicide, all committed with captive-bolt livestock-stunners. The investigation of skull caps revealed roundish holes at the entry sites which were beveled-out in a paraboloid-like manner on the inner aspect. These defects were reproducible in test shots with various strengths of ammunition and different materials as targets.

[Fatal child neglect in West Germany 1 January 1985 to 2 October 1990. Results of a multicenter study]. / Tödliche Kindesvernachlässigung in der Bundesrepublik Deutschland im Zeitraum 1.1.1985 bis 2.10.1990. Ergebnisse einer multizentrischen Studie.

UNLABELLED: Up to now reliable data were available on cases of lethal child neglect in the area of the Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period from 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 19 cases of lethal child neglect. Extrapolated to all institutes of legal medicine, this corresponds to 20 cases and thus 3.5 cases a year in the whole of West Germany in the period studied. There is to be added a dark-field which cannot be limited more precisely. However, the cases of fatal child neglect might have occurred much more seldom than fatal child abuse caused by use of physical violence. Slightly more than half the victims were younger than 1 year, the oldest one was 7 10/12 years old. Most frequently the children died of starvation and thirst. Mostly the mothers/nursing mothers killed the child alone or together with the victim's father/stepfather. In the majority of the cases there was not a close affection between parents and child. Nearly 30% female/male perpetrators suffered from chronic alcohol abuse. Only 15 (= 56%) of 27 female/male perpetrators were sentenced to imprisonment (period between 7 months on probation and 10 years). Mitigation circumstances existed for nearly half the persons sentenced to imprisonment. It is true that child neglect is a rarer crime, but the experts of legal medicine always have to indicate errors made during the external inspection of the corpse (among others failures to see indications of neglect).

[Fatal child abuse (caused by physical violence) in Germany during 1 January 1985 to 2 October 1990. Results of a multicenter study]. / Tödliche Kindesmisshandlung (durch physische Gewalteinwirkung) in der Bundesrepublik Deutschland im Zeitraum 1.1.1985 bis 2.10.1990. Ergebnisse einer multizentrischen Studie.

UNLABELLED: No reliable data are available on cases of lethal child abuse (by active force) in the area of Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 58 cases of lethal child abuse. Extrapolated to all institutes of legal medicine, this corresponds to 62 cases in all of West Germany in the period studied. An approximately equal number of unreported cases should be added to this figure. Including unreported cases, at least 20 cases of lethal child abuse occurred per year; thus only one in every two cases ever came to light. Almost two thirds of the victims were younger than one year old. At autopsy 59% exhibited signs of repeated abuse at autopsy. By far the most common cause of death was direct impact from a blunt object, usually to the head. Mostly, the male person to whom the victim relates most closely (father, stepfather, partner of the mother) has killed the child. Twenty-one of the 74 persons charged saw the charges against them dropped or were acquitted due to lack of evidence; 51 received sentences ranging from one year probation to life. In the remaining two cases the outcome of the trial was unknown. Signs of abuse were readily apparent at autopsy in almost all cases. The high number of unreported cases underscores the need to educate medical students and practicing physicians to be on the look-out for signs of abuse and argues for an increase in the rate of autopsy.

[Unusual cases of self-asphyxiation]. / Ungewöhnliche Fälle von Selbsterdrosseln.

Based on the description of the findings of four cases of self-strangulation with multiple knotting of the strangling device examined by the authors general criminological and specific forensic criteria for differential diagnosis of suicide and commission of the offence by another person are discussed. Though multiple knotting of the strangling device, caught hair and parts of clothes and concomitant injuries may also be seen in cases of suicide, they primarily justify the suspicion that the death was caused by another person. If it is one of those rare cases of self-strangulation with multiple knotting, the presence of symptoms of congestion in the head area, which may occasionally be absent in other cases of strangulation, is necessary for pathophysiological reasons.

[Atypical bullet entry injuries. A case report and experimental contribution]. / Untypische Einschussverletzungen. Ein kasuistischer und experimenteller Beitrag.

In order to elucidate the contradictory findings in cases of suicide or homicide with firearms, firing tests were performed with various weapons shot at textile samples, block gelatine, animal and human skin, and pigs' heads. Ricochets were produced at different angles of incidence and bullets were shot through various materials introduced between the target and muzzle. The morphology and emission spectrum analyses of the entry holes were investigated, and the projectiles were collected and inspected. The morphological and chemical alterations observed at the entry holes were classified and discussed.

[Reproduction of atypical bullet exit wounds]. / Zur Reproduktion atypischer Ausschusswunden.

Contradictory findings from experiments designed for the reconstruction of the circumstances in crimes committed with firearms induced us to systematically investigate the conditions leading to the occurrence of non-typical bullet exit wounds. For this purpose, skin samples and pig heads were fired at with different types of small arms and, on the exit side, the skin was brought into contact with various materials. The bullet exits were investigated morphologically and by means of emission spectrum analysis. The results from these investigations are classified and discussed.

[Diagnosis of lumbar intervertebral disk prolapse by computed tomography. A comparative clinical study between myelographic, computed tomographic and the surgical research results with 158 patients]. / Diagnostik lumbaler Bandscheibenvorfälle durch Computertomographie. Eine klinische Vergleichsstudie zwischen myelographischen, computertomographischen und operativen Untersuchungsergebnissen von 158 Patienten.

The diagnostic accuracy of CT in cases of lumbar disk prolapse was investigated on the basis of a group of 158 of our own patients who were divided into three separate groups. CT findings were compared on the one hand with myelograms and on the other with results of surgery. Simultaneously performed myelographic and CT examinations produced different diagnostic findings in 7 out of 80 lumbar disks (approx. 9%). These deviating findings ranged from gradual differences (in 3 cases) to completely contradictory findings (in 4 cases). In 31 patients who underwent surgery, approximately the same amount of false-positive and false-negative findings were obtained in preoperative diagnosis using CT as with myelography. The overall accuracy calculated for non-invasive computerized tomography was 93.7%, while for myelography it was 90.7%. Out of a further 91 patients in whom myelography was not performed and whose condition was checked surgically, the diagnosis had been established correctly by CT in 88. This represents a degree of accuracy of 96%. The vertical and lateral location of the disk prolapses as determined by CT corresponded with findings at surgery in every case. It is concluded from the results of these investigations that CT should be given absolute priority over myelography in the diagnosis of lumbar disk prolapse and that if there is a correlation between clinical history, neurological deficiency symptoms, and CT findings, myelography is unnecessary, even for surgery. Only if there are discrepancies between the findings myelography is indicated as a supplementary examination. CT and myelography are examination methods which complement, rather than complete with one another.

[Significance of skeletal scintigraphy for oncological practice]. / Bedeutung der Skelettszintigraphie für die onkologische Praxis.

Our experiences with more than 2000 bone scintigrams in 803 tumour patients underline the high ranking of skeletal scintigraphy in oncology. Among our patients--who, as a matter of fact, represented a selected material--the rate of false negative scintigraphs was less than 1%. The incidence mentioned in literature is between 1 and 3% (6, 11, 38, 41). By balanced and differentiated assessment of bone scintigrams and analogous x-ray films (plain radiographs, spot-film radiographs, if necessary x-ray tomograms), taking into consideration storage anomalies in respect of localization, form and storage intensity, false-positive results can be reduced to a minimum; as a matter of fact, we believe that in oncology patients the quota of false-positive results can be reduced to less than 3%. In tumour patients, the question as to whether there are any bone metastases, can be correctly answered with a probability of about 96% by means of skeletal scintigraphic imaging and the analogous x-ray film as a complementary examination. The bone scintigram is excellently suited for effecting malignoma staging. It is, in fact, superior to all other methods. Skeletal scintigraphic imaging enables the identification of metastases earlier than any other method. It is the most sensitive primary search method which can be utilized for on-target application of x-ray diagnostic methods. Both solitary and multiple osseous metastases can be accurately localized by scintigraphy. The early identification of skeletal metastases in skeletal regions with endangered stability, is particularly important, since an impending spontaneous fracture can be prevented by osteosynthesis or local radiation therapy. Changes in the growth of metastases under radiation and/or chemotherapy can be reliably observed by scintigraphic follow-ups, and can be assessed to determine whether there is a continued growth or a remission. If scintigram and x-ray film are employed side by side--a procedure which is imperative during first examination and later with specific courses of the disease, the low grade specificity of scintigraphy is largely compensated by the x-ray method.

[Lipomas of the liver--differential diagnosis of liver metastases by computerized tomography]. / Lipome der Leber - Differentialdiagnose gegenüber Lebermetastasen mit Hilfe der Computertomographie.

It is reported about a female patient with two lipomas of the liver. The special diagnosis and the differentiation against metastases and other malignant tumors of the liver are only possible by means of computertomography. Scintigraphy and sonography do not allow a differential diagnosis. On the one hand lipoma of the liver is a very rare and benign disease but on the other hand a correct diagnosis may be - like in this case - very important because of therapy and prognosis.

[Perforation of the large intestine caused by compressed air. Experimental studies reconstructing compressed air insufflation]. / Dickdarmperforation durch Pressluft. Experimentelle Untersuchungen zur Rekonstruktion einer Druckluftinsufflation.

A foreign worker died after a compressed air injury. The insufflation of high pressure air into the anus caused multiple ruptures in the part anterior of the dilated sigmoid and colon descending. For the reconstruction of the case it was necessary to know the minimum distance between the nozzle and the gluteal region. Experimental work has shown that clothing does offer protection against the high pressure air and colon perforations can only be expected if there is a small distance between the jet of the compressed air and the anal region.

[Traumatic infarction following stab wound of the heart (author's transl)]. / Traumatischer Infarkt nach Stichverletzung des Herzens.

Case report about a myocardial infarction following stab wound of the left atrium including a complete severance of the left coronary artery: An athletic 35-year-old man suffered a latero-medial stab wound of the thorax. The knife had penetrated the left lung and the atrium of the hypertrophic left heart. Postoperatively, the patient developed a heart infarction; 40 h after trauma he died. The postmortem revealed traumatic necrosis of the left atrium, an intraoperatively undiscovered complete severance of the ramus circumflexus arteriae coronariae sinistrae and an antero-lateral ischemic cardionecrosis of the left ventricle. The location of the infarction could be explained by an extreme right preponderance of the coronary blood supply. Traumatic and ischemic myocardial necrosis differed distinctly in the amount of contraction bands. Other causes for such morphological changes like catecholamine-cardiomyopathy (so-called epinephrine myocarditis) or heart operations are discussed.

[The importance of postmortem influences on the visibility of strangulation marks]. / Die Bedeutung postmortaler Einflüsse auf die Erkennbarkeit von Strangmarken.

A 44 year old male alcoholic was throttled by his wife. The visible white furrow after strangulation was massaged with unguentum; afterwards, the corpse was transported with a scooter by the sons of the victim into a lake. Here, the man was found 24 hours later without any external signs of strangulation. Experimentally produced strangulation furrows (at lower legs of human deceased and at neck of shaved and deeply narcotized guinea-pigs) disappeared when exposed to water or treated with ointments.

[Investigations on the morphology and biochemistry of wound healing after injury of the liver (author's transl)]. / Untersuchungen zur Morphologie und Biochemie der Wundheilung bei Leberschnittverletzungen.

The early phase of wound repair after liver incisions was investigated by histological, enzyme-histochemical, and biochemical methods in guinea pigs. There are considerable differences in cellular and histochemical reactions in comparison to incisions of the skin: 1. The rapid leukocytic reaction showed little change during the observation interval (48 h). In short survival times epithelial cells show signs of hypoxidosis and loss of glycogen at the edge of an incision. Proliferation of organ-specific and mesenchymal cells was observed after more than 24 h. 2. Alterations of the investigated enzymes in the traumatic area are important diagnostic parameters in the early stages of wound healing. 3. In the early 12 h after injury distinct increase of histamine was observed, while serotonin was noticed to decrease. 4. Therefore, the determination of wound age in the early wound reactions after injuries of the liver should include enzymehistochemical methods.