Gunshot wounds in parenchymatous organs: the morphology mainly depends on the physical properties of the affected tissues.

In contrast to gunshot wounds in skin and bone, the medico-legal literature pays little attention to the appearance of bullet penetration sites in abdominal organs. It was only in 1983 that Metter and Schulz published an article entitled "Morphological features of gunshot wounds in the liver and spleen." According to their observations, the organs in question showed stellate tears at the bullet penetration sites resembling skin wounds from contact shots to body regions having a bony support. The study presented simulated the real conditions by means of test shots to composite models consisting of porcine organs embedded in ballistic gelatin. The ammunition used was pistol cartridges 9 mm Luger with full metal jacket round nose bullets. The shots were video-documented with a high-speed camera in order to record the bullet's travel through the target. In addition, the composite models fired at underwent CT examinations followed by a macroscopic assessment of the organs. The study confirmed the findings of Metter and Schulz with regard to the star-like appearance of gunshot wounds in the liver and spleen. Likewise, the kidney showed radiating tears originating from the bullet path, whereas the wound track in pulmonary tissue was tube-shaped and lacked additional cracks. The varying wound patterns in parenchymatous organs can reasonably be explained as a consequence of the respective viscoelastic tissue properties.

Differing sizes of bullet entrance holes in skin of the anterior and posterior trunk.

The aim of the present study was to establish whether the size (diameter and area) of bullet entrance holes in skin varies between distant shots to the anterior and posterior trunk, respectively, when using the same ammunition (in concreto pistol cartridges 9 mm Luger). For that purpose, specimens of porcine skin from the belly region and the back were taken (10 samples each) and shot at from a distance of 1.6 m. The entrance holes were photo-documented under standardised conditions. After image processing for contrast enhancement, the maximum diameter and the area of each skin defect were measured automatically by means of an image analysis system. Both size parameters differed significantly depending on the body region affected. On the back with its comparatively thick dermis, the skin defects were considerably smaller than those on the ventral trunk where the corium is less thick. This difference can be explained by the fact that the elastic properties of skin are strongly determined by the connective tissue which is especially rich in fibres. The study results were consistent with the authors' casework experience and support the assumption that the entrance site of gunshot wounds has a major influence on the size of the bullet hole in skin.

A special type of scald caused by prolonged exposure to slowly heated water.

When skin is subjected to water temperatures gradually rising from moderate to critical ranges for a prolonged period of time, the resulting scalds will initially present as reddening, followed by blistering and at last by full-thickness burns. On changing from second- to third-degree burn, the blisters stop to become enlarged and solidify due to heat-induced coagulation necrosis. Such gradually intensifying tissue damage results in multiple firm skin blisters together with third-degree burn of the affected area. The initially serous blister fluid assumes a jelly-like consistency as the proteins undergo denaturation. Scalds of this special type may occur in persons taking a bath and becoming incapable to act so that the warm water tap remains turned on or a hairdryer continues to work after having been dropped into the bath water. On the basis of two relevant fatalities (suicidal electrocutions in bathtubs by means of hairdryers), the macroscopic and histological appearance of blisters which only secondarily turned into a full-thickness scald is compared with blisters in genuine second-degree scalds. The blister fluid of the latter ones was also investigated as to their protein composition and hemoglobin concentration.

Pattern injuries from blows with the muzzle end of a handgun.

Pistols, revolvers and blank guns are not only used to discharge cartridges, but also for hits to the victim. In such cases, the blows preferably affect the head and/or the interposed hands protecting the body. The impact is mostly exerted either by the grip of a pistol or the butt of a revolver. In vigorous thrusts inflicted with the muzzle end of the weapon, the edge of the barrel may produce circular punch lesions with central skin flaps roughly corresponding to the bore. As in other kinds of pistol-whipping, the scalp wounds may be associated with fractures of the skull and even with brain contusions. Using the example of a homicide committed by pistol-whipping, the morphological features of blunt injuries from a handgun's muzzle are presented. The characteristic wound pattern found on the victim's head could be reproduced experimentally by forceful blows to the forehead of a slaughtered pig. In the case presented, the dominant hand of the perpetrator showed friction blisters due to prolonged striking with an unhandy tool in the form of a pistol.

Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis.

Acute subdural hematomas are mostly due to blunt traumatization of the head. In rare instances, subdural bleeding occurs without evidence of a previous trauma following spontaneous hemorrhage, e.g. from a ruptured aneurysm or an intracerebral hematoma perforating the brain surface and the arachnoid. The paper presents the morphological, microbiological and toxicological findings in a 38-year-old drug addict who was found by his partner in a dazed state. When brought to a hospital, he underwent trepanation to empty a right-sided subdural hematoma, but he died already 4h after admission. Autopsy revealed previously undiagnosed infective endocarditis of the aortic valve as well as multiple infarctions of brain, spleen and kidneys obviously caused by septic emboli. The subdural hematoma originated from a subcortical brain hemorrhage which had perforated into the subdural space. Microbiological investigation of the polypous vegetations adhering to the aortic valve revealed colonization by Streptococcus mitis and Klebsiella oxytoca. According to the toxicological analysis, no psychotropic substances had contributed to the lethal outcome. The case reported underlines that all deaths of drug addicts should be subjected to complete forensic autopsy, as apart from intoxications also natural and traumatic causes of death have to be taken into consideration.

Skin blister formation together with patterned intradermal hematoma: a special type of tire mark injury in victims run over by a wheel.

A traffic accident victim run over by a vehicle may show a patterned skin hematoma reflecting the grooves of the tire's profile. Apart from this well-known type of imprint mark, the affected skin can also be blistered provided that the wheel exerts high pressure on the body for a prolonged period of time. The macro- and micromorphological findings as well as the protein composition of the blister fluid were investigated on the basis of a relevant autopsy case. Analogous to blisters associated with hanging marks, the transudation of serous fluid with consecutive detachment of the epidermis is interpreted as a pressure-related effect which cannot be regarded as a sign of vitality.

Fat from contused adipose tissue may cause yellow discoloration of clothes in blunt trauma victims.

In some fatalities from intense blunt trauma, the victims' clothes show strikingly yellow discoloration being in topographic correspondence with lacerated skin and crush damage to the underlying fatty tissue. This phenomenon is especially pronounced in light-colored textiles such as underwear made of cotton and in the absence of concomitant blood-staining. The constellation of findings seems to indicate that the fabric has been soaked with liquid body fat deriving from the contused adipose tissue. To check this hypothesis, textiles suspected to be contaminated with fat were investigated in 6 relevant cases. GC-MS-analysis proved the presence of 11 fatty acids. The fatty acid composition was similar to that of human adipose tissue with a high proportion of oleic acid (18:1). In total, the morphological and chemical findings demonstrated that the yellow discoloration of the victims' clothes was caused by fat from traumatized adipose tissue.

Muzzle imprint mark: a patterned injury which may be constituted of intradermal blood extravasations.

The muzzle imprint mark in contact shots is usually regarded as a patterned pressure abrasion depicting the barrel end as well as adjacent constructional components of the weapon. Due to parching after exposure to air, the affected skin assumes a brown color, especially along the contours of the impacting structures. Apart from this well-known type of epidermal damage, the imprint mark may also be formed by intradermal hemorrhages. In some cases, these intracutaneous bleedings manifest themselves as circular, curved or straight reddish lines mirroring the surface relief of the weapon's muzzle end. To estimate the frequency of skin hematomas in muzzle imprints, 35 consecutive contact shots to the head (temple, forehead, submental and occipital region) were evaluated. In 3 cases, the muzzle imprint mark exclusively consisted of intracutaneous bruises surrounding the bullet entrance hole. In 14 cases, the muzzle imprint was composed of both excoriations and intradermal hematomas.

Complex suicide with homemade nicotine patches.

Suicide by self-poisoning is rather common around the world. This paper presents an exceptional complex suicide in which nicotine was applied in the form of self-made patches soaked with an extraction from fine-cut tobacco. In addition, the 51-year-old suicide victim took a lethal dose of diphenhydramine. Toxicological analysis also revealed the presence of tetrazepam in subtherapeutic concentrations. The scene of death suggested an autoerotic accident at first, as the body was tied with tapes, cables and handcuffs. As a result of the entire investigations, the fatality had to be classified as a suicidal intoxication by nicotine and diphenhydramine.

Complex suicide by ethanol intoxication and inhalation of fire fumes in an old lady: interdisciplinary elucidation including post-mortem analysis of congener alcohols.

An 88-year-old woman committed suicide by drinking a toxic amount of highly concentrated alcohol and setting two rooms of her flat on fire. As there was not enough oxygen, the fire went out, however. At autopsy, no thermal lesions were found on the body, but soot depositions in the airways and a COHb value of 14% pointed to the inhalation of fire fumes. The ethanol concentration in femoral blood was 6.62 per mille. The gastric mucosa was fixed by the ingested alcohol and showed hardly any autolytic changes despite a post-mortem interval of five days. Congener analysis of the gastric contents and the femoral blood indicated the uptake of a fruit distillate or its foreshot.

Tooth aspiration: its relevance in medicolegal autopsies.

Tooth aspiration in adulthood is an uncommon autopsy finding. The paper presents two cases in which maxillary incisors had been avulsed and inhaled during hospital treatment and in the course of maxillofacial trauma, respectively. In the first case, repeated attempts to remove the aspirated tooth by means of flexible bronchoscopy led to perforation of the bronchial wall with consecutive bleeding into the deep airways and fatal asphyxia. In the second case, the fact of tooth aspiration remained undetected throughout the 3-day survival time until death from craniocerebral trauma. The paper points out the forensic aspects of tooth aspiration against the background of the relevant clinical literature.

Experimental simulation of reentry shots using a skin-gelatine composite model.

A bullet that has passed in and out of one body segment may continue its way into another part of the body causing a second entrance ("reentry") wound, which is often said to have an atypical and sometimes confusing appearance. To analyze this problem in a systematical approach, 9-mm Parabellum full metal-jacketed projectiles were fired at skin-gelatine composite models simulating the consecutive passage of a bullet through two parts of a body. When there was a distance between the two segments, the primary exit and the reentry skin wounds did not show any distinctive features differing from usual gunshot injuries. In the case of contact between exit and reentry site, the corresponding skin wounds resembled each other as both had central tissue defects surrounded by abrasion areas. The subsequent investigation of the simulant revealed that skin particles from both the exit and the adjacent reentry site had been displaced in the direction of the shot along the whole bullet track of the second segment. The morphological findings are presented and discussed with respect to the pertinent literature, and possible physical ballistic explanations are suggested.

Analysis of mitochondrial length heteroplasmy in monozygous and non-monozygous siblings.

The segregation of mitochondrial genomes and the inheritance of mitochondrial DNA are constant matters of debate. To obtain more information about this issue and to answer the question whether or not it is possible to distinguish mitochondrial DNA (mtDNA) samples from monozygous individuals by analysing heteroplasmic length variants, 290 monozygous and 121 dizygous twin pairs and 34 sets of multiples were studied by RFLP and partly by direct sequencing. A factor D describing the respective pattern of length variants in a given sample was also calculated. The results show that monozygous individuals exhibit a significantly lower median and closer distribution of D than non-monozygous siblings. Thus, a differentiation of mtDNA samples from monozygous twins by this trait is not possible. The high percentage of heteroplasmic individuals, the low median of the D values and the unexpectedly very similar distribution of length variants in monozygotic individuals support the existence of a relatively wide bottleneck or the assumption of a regeneration of length heteroplasmy following a tight bottleneck and agree with a random segregation of mtDNA genomes in dividing oocytes.

Simulation of an assault with self-tying and vaginal insertion of metal objects.

Report on a recent case, in which a 28-year-old woman was found tied in her flat by her son who called the police. When the police arrived, the woman was lying on the floor fully conscious. The face and upper chest, the arms and legs were wrapped with broad adhesive tape. After the police had cut the tapes, she stated that she had been attacked by two men who demanded a large amount of money and made her unconscious by pressing a strange smelling cloth against her mouth. In the course of the gynaecological examination, several teaspoons and pieces of jewellery were found in her vagina. Neither the genital region nor the other parts of the body showed any injuries. When she was confronted with the results of the medicolegal examination, she admitted self-infliction for the purpose of simulating an offence.

Textile fibres along the bullet path--experimental study on a skin-gelatine composite model.

In the past, the presence of textile fibres in the bullet track of gunshot injuries in body regions covered with clothes was used to differentiate between entrance and exit wounds; as with handguns, a displacement of textile fibres was considered possible only in the direction of the shot. In the present study, the transfer of textile fibres from the entrance and exit regions into the bullet path was systematically investigated with the help of a skin-gelatine composite model. For this purpose, the skin of the bullet entrance and exit region was covered with textile fabric (jeans or jersey material), before conducting four test series of ten test shots each firing a 9-mm Parabellum full-jacketed projectile from a distance of 2 m. The length of the bullet track was 25 and 8 cm, respectively. Subsequently, the bullet tracks were microscopically investigated in sections for the presence of textile fibres. In all the investigated bullet tracks, textile fibres both from the entrance and exit regions could be demonstrated. The distribution pattern depended on the length of the bullet path and the extension of the temporary cavitation. The results are discussed in relation to the relevant literature.

Effect of shortening the barrel in contact shots from rifles and shotguns.

In a suicidal gunshot fired to the chest from a carbine, the barrel of which had been shortened to half its original length, an unexpectedly large degree of destruction of the anterior thoracic wall with extensive undermining of the subcutis was found. This phenomenon was investigated for reconstructive purposes by firing test shots from two different long guns (caliber 7.92 x 57 repeating rifle with full-jacketed pointed bullet and caliber 12/70 single-barreled shotgun with shotgun slug) into blocks of soap (38 x 25 x 25 cm). The contact shots were fired before and after shortening the barrels (repeating rifle from 60 to 30 cm and single-barreled shotgun from 72 to 36 cm). The volume of the cavities in the simulant was visualized three-dimensionally with the help of a multislice computed tomography (CT) scanner and calculated sectionally. With the repeating rifle and the single-barreled shotgun, the shots from the sawed-off barrels produced significantly larger cavity diameters in the first section of the bullet track. This effect is attributable to the fact that, with a shortened barrel, the gas pressure at the muzzle is higher, thus, leading to increased expansion in the initial part of the wound track in contact shots.

Toxicological analysis after asphyxial suicide with helium and a plastic bag.

A 23-year-old man was found on a raised hide in lying position, the head wrapped in a plastic bag connected with a helium gas cylinder by a polypropylene tube. The autopsy did not show any specific findings nor did the routine toxicological analysis reveal significant information regarding the cause of death (BAC 0.9 mg/g, diphenhydramine 0.81 microg/ml in heart serum). For the detection of helium in the lungs, gas samples from both lungs were collected by a method ensuring minimal dilution. Gas analyses were performed using a GC-MS with a split-splitless injector and a headspace syringe. As carrier gas the commonly used helium was replaced by nitrogen. Helium was found in clearly elevated concentrations in gas samples from both lungs. Therefore, suffocation by breathing helium enriched, and thus oxygen deficient atmosphere, can strongly be assumed as the cause of death.

Medical criminalistics.

Medical criminalistics is an essential part of legal/forensic medicine. It includes the clinical examination of surviving victims and suspects, the inspection of the scene in suspicious deaths with subsequent performance of medico-legal autopsies, the assessment of (biological) traces and the reconstruction of criminal events under medical aspects. Just as the circumstances of life and the manifestations of crime are changing with time, there is a permanent alteration regarding the issues of medical criminalistics. Legal/forensic medicine is a university subject in most countries and therefore, research work is one of the main tasks also in medical criminalistics. In contrast to clinical medicine and basic research, some common study designs are not suitable for the special needs of medical criminalistics, whereas other types are more appropriate like epidemiological evaluations, cross-sectional studies and (retrospective) observation studies. Moreover, experimental model tests and case reports also rate high in medical criminalistics.

Gunshot-related displacement of skin particles and bacteria from the exit region back into the bullet path.

In previous studies, it was shown that there is a gunshot-related transport of skin particles and microorganisms from the entrance region into the depth of the bullet path. The present study deals with the question of whether gunshots may also cause a retrograde transport of skin particles and microorganisms from the bullet exit region back into the bullet path. For this purpose, we used a composite model consisting of rectangular gelatin blocks and pig skin. The skin pieces were firmly attached to the gelatin blocks on the side where the bullet was to exit. Prior to the test shots, the outer surface of the pig skin was contaminated with a thin layer of a defined bacterial suspension. After drying the skin, test shots were fired from a distance of 10 m using cartridges calibre .38 spec. with different bullet types. Subsequent analyses showed that in all shots with full penetration of the composite model, the bullet path contained displaced skin particles and microorganisms from the skin surface at the exit site. These could be regularly detected in the distal 6-8 cm of the track, occasionally up to a distance of 18 cm from the exit hole. The distribution of skin particles and microorganisms is presented and the possible mechanism of this retrograde transport is discussed.

Gunshot-related transport of micro-organisms from the skin of the entrance region into the bullet path.

The skin defect of a gunshot entrance wound is caused by the retrograde and anterograde displacement of skin particles. In the present study, we investigated whether gunshots to bacterially contaminated skin are associated with the transport of micro-organisms into the bullet path. The shots were fired into composite models of pig skin and gelatin blocks. The outer surface of the skin was covered with a thin layer of a defined bacterial suspension [green fluorescent protein-labelled Escherichia coli in the preliminary test and Staphylococcus epidermidis, DSM 1798, in the main test series]. After the bacterially contaminated fluid had dried, test shots were fired from a distance of 5 and 10 m using calibre .38 Special cartridges with different bullet types (round nose, truncated cone, hollow point and flat nose). Subsequent bacteriological analyses showed that all the bullet tracks in the gelatin serving as tissue simulant contained displaced micro-organisms from the skin surface. The results are presented and discussed with reference to the transport of skin particles into the depth of the wound track.