The value of subendocardial haemorrhages as an indicator of exsanguination and brain injury--a retrospective forensic autopsy study.

INTRODUCTION: Subendocardial hemorrhages (SE) have been associated with multiple causes of violent and non violent deaths in forensic autopsies such as fatal exsanguination, brain injury and intoxications. METHODS: The presented retrospective study investigates the overall incidence and various causes by an analysis of a total of 1331 forensic autopsies based on autopsy reports. RESULTS: The results show that head injury and significant blood loss alone or in combination are the main mechanisms of death associated with SE. The incidences of SE were 50% in exsanguination, 80% in combined exsanguination and head injury, and 31% in solitary head trauma. DISCUSSION: On the basis of the study results it can be concluded, that SE are important indicative signs for both fatal exsanguination and brain injury at medico-legal autopsies.

Forensic assessment of survived strangulation.

By a retrospective analysis of all survived strangulation cases examined at the Institute of Forensic Medicine of Berne, Switzerland between 1987 and 2002, the authors tried to find out, if findings and symptoms of victims could be related to the fierceness of the assault and the mode of strangulation and if general evaluation criteria could be established on the basis of objective findings. One hundred and thirty-four survived strangulation cases were analysed on the basis of written reports, photographies and schematical sketches. Findings and symptoms reflected the fierceness of the assault in 71% of all cases by displaying a continuum of findings from minor injuries to severe traumatisation. This applied especially for cases of manual strangulation while other modes of strangulation resulted in different constellations of findings. As a result of this study, the authors deem the following classification of three degrees of severity as practical on condition that a complete forensic medical examination was performed upon the surviving victim shortly after the incident of strangulation: Light strangulation, confined to skin abrasions and/or reddening of the skin of the neck. Moderate strangulation, defined as bruising to, and/or bleeding from the neck, and/or damage to deeper soft tissues or the larynx, as exhibited by the symptoms of sore throat, difficulty in swallowing, and hoarseness. Severe, life-threatening strangulation if the victim presents petechial bleedings as a result of venous congestion with or without accompanying loss of consciousness.

[Certain or possible lethal medical malpractice: what is to do afterwards?]. / Sicherer oder möglicher letaler Behandlungsfehler: Was ist danach zu tun?

In case of a possible or certain lethal case of medical malpractice the following procedure is recommended: 1. Scrutinize every death of a patient during or after a medical treatment. Address the following questions: "Did everything proceed correctly?", "Could death have been prevented?", "This should not have been happened". 2. Report to the head physician, to the hospital management and administration in order to coordinate the further procedures. 3. Save all the evidence: Perfusions, empty phials, opened drug packages. Leave all catheters, tubes, drainages on the body! Leave any technical equipment, for example anesthetic machines untouched. Save all prior blood and urine samples taken from the patient. Seal medical history and documentations. 4. Order a memory protocol of the events by all involved persons. 5. Refrain from clinical autopsy. Forensic autopsy, indicated in these circumstances, can only be authorized by the district attorney (see point 7). If in doubt, seek counseling from an institute of forensic medicine by telephone (if requested: anonymously). 6. Put "non natural death" on the death certificate in case of a certain and unclear death in case of a possible medical malpractice. 7. Report any possible or certain case of lethal medical malpractice to the district attorney (obligation to report). The district attorney will authorize a 8. Inform the relatives of the deceased. Apologize, show regret and concern but do not address the question of guilt. 9. Inform your third party insurance (this does not mean an admission of guilt).

[Survived offenses of physical and sexual integrity--the responsibilities of the emergency physician]. / Uberlebte Delikte gegen die körperliche und sexuelle Integrität--die Aufgaben des Notfallarztes.

The examination of living victims of physical and sexual assault as well as the documentation of injuries are tasks of the emergency physician. His observations and the documentation by photography, diagrams and description of findings are the basis for further legal proceedings. This article addresses the duties and responsibilities as well as the practical procedures of the physician regarding the announcement of incidents indicating crimes against the corporal and sexual integrity of patients to the authorities and the documentation of findings in general and addresses some special situations likely to occur in any medical emergency.

Fatal scuba diving incident with massive gas embolism in cerebral and spinal arteries.

CT and MRI have the potential to become useful adjuncts to forensic autopsy in the near future. The examination of fatal injuries facilitates a profound experience in the clinical-radiological examination of these cases; the more severe findings in corpses with autopsy verification can help one to understand the tiny signs seen in clinical cases of surviving victims. We present the case of a 44-year-old male diver who died from severe decompression sickness after rapid ascent from approximately 120 m. Post-mortem CT and MRI studies of the brain and spinal cord revealed extensive gas inclusions in cerebral arteries, spinal arteries and cerebrospinal fluid (CSF) spaces, while the intracranial venous sinuses remained unaffected. These findings were confirmed at autopsy. Appropriate imaging techniques can help forensic pathologists to aim their autopsies at findings that might otherwise remain undetected.

Gunshot residue patterns on skin in angled contact and near contact gunshot wounds.

The goal of this study was the reproduction of shape and pattern of gunshot residues in near contact and contact gunshot wounds by a series of experimental gunshots on a skin and soft tissue model. The aim was to investigate the shape and direction of soot deposits with regard to the muzzle according to different muzzle-target angles, firing distances, type of ammunition and weapon and barrel length. Based on a review of the literature and on the results of the experiments the authors could make the following statements of gunshot residues in angled contact and close contact gunshot: (1) gunshot residues on the target surface can be differentiated in a "inner" and "outer powder soot zone"; (2) the outer powder soot zone is much less visible than the inner powder soot zone and may lack on human skin; (3) with increasing muzzle target distance both inner and outer powder soot halo increase in size and decrease in density; (4) in angled shots the inner powder soot halo shows an eccentric, elliptic shape which points towards the muzzle, regardless of ammunition, calibre and barrel length; (5) the outer powder soot points away from the muzzle in angled contact and close contact shots.