[Definition of a "domestic-setting corpse"--a retrospective study of 211 discoveries]. / Definition der "Wohnungsleiche"--eine retrospektive Studie anhand von 211 Leichenfunden.

In Germany, the term "domestic-setting corpse" is regularly used both in the medicolegal field (daily work, specialist literature) and by the general public (press, novels). The only formal definition of the term is in the German-language textbook "Basiswissen Rechtsmedizin" (Madea and Dettmeyer 2007). In this retrospective study, we compared the criteria for this definition with our findings. Autopsy reports from the Institute of Forensic Medicine at the Justus Liebig University in Giessen, Germany, for the period between 2005 and 2011 (including February), were reviewed retropectively to see if the criteria for this formal definition could be found. We chose a postmortem interval of more than 24 hours and discovery of the corpse in a private home as inclusion criteria for our study (n = 211). We could verify four of the criteria for the definition ("advanced signs of decomposition", "reclusiveness", "unclear cause of death", "difficult to identify") in our study. One criterion ("frequently a long postmortem interval") was too vague to be of use, and two further criteria ("discovery circumstances" and "high frequency of active alcohol dependence") could only be partially confirmed. In almost half of our cases there were, however, signs of general substance abuse. The proportion of male "domestic-setting corpses" was distinctly higher than that of females (approx. 3:1). The average age-at-death was 50.1 years for men, and 57.8 years for women, and thus clearly below the average life expectancies. In over half of the cases - even those with explicitly mentioned advanced facial decay--the identification method had not been noted. In the formal definition, the criteria "discovery circumstances" and "alcoholism" thus need to be more precisely defined. Also, due to the inexplicit time range, the criterion "frequently a long postmortem interval" was too vague to be applied to, or compared with, our cases as a classic criterion. We suggest specifying a minimum postmortem interval of 24 hours for "domestic-setting corpses". In addition, more attention should be paid to the identification of "domestic-setting corpses". To date, investigation authorities frequently seem to assume that a corpse discovered in a private residence is that of the home owner or occupant.

[The value of skull-photo superimpositions in identifying corpses found in domestic settings]. / Uber den Wert des Schädel-Bild-Vergleichs zur Identifizierung so genannter Wohnungsleichen.

The identification of decomposed corpses found in domestic settings is frequently problematic because comparative material for methods such as forensic odontostomatology, comparative X-ray analysis, or DNA analysis, is not available. In the case presented here, a photograph from an old, expired passport could be used to successfully identify a "domestic setting" corpse in a skull-photo superimposition. In an additional DNA analysis, 13 STR-loci could be amplified from tissue samples taken from the corpse. DNA comparison with the presumed brother of the deceased yielded a probability of 97.09% for siblingship. Y-STR-analysis was, therefore, performed. The results showed that all of the systems for the presumed brother and the corpse conformed, with the exception of the DYS390 locus, in which allele 21 was found for the corpse and allele 22 for the brother. Despite the rapid development of other identification procedures, skull-photo superimpositions remain an important means of identification. Last not least this is due to the increasing ubiquity of personal photo documents in the age of digital photography. The validity of the results from a DNA analysis in an identification process depends largely on the authenticity of the samples available for comparison and the degree to which the DNA from the corpse is preserved. In the case presented by the authors, positive identification of the corpse solely on the basis of the DNA analysis would not have been possible. Numerous constellations can be imagined for decomposed corpses found in domestic settings for which skull-photo superimpositions may be the only possible option for identifying the corpse.

[Criteria for the classification as a "domestic-setting corpse"--a literature search and review to define the term]. / Kriterien einer "Wohnungsleiche"--Literaturstudie zur Definition eines Fachbegriffs.

In German medical and media circles (daily routine, specialist literature, press, novels), the term "domestic-setting corpse" is frequently used, but the term is only vaguely defined. The authors thus decided to perform an in-depth study of the literature, including historic textbooks and all German- and English-language medicolegal journals, going as far back as their first issues, in an attempt to more clearly define the term. Inclusion criteria used in the search were a post-mortem interval of at least 24 hours prior to discovery and discovery of the corpse in a domestic setting. In the literature, 37 cases that complied with the above-mentioned inclusion criteria were found. These cases frequently described "advanced decomposition", often "unclear cause of death" and "problems in identification". These characteristics can thus be considered as being additional pointers in the definition. However, we suggest that the two general defining characteristics of a "domestic-setting corpse" are a post-mortem interval of more than 24 hours before discovery and the discovery of the corpse in a domestic setting.

[Deaths in hotels]. / Tod im Hotel.

There are no verified statistics about deaths occurring in hotels, and only a few cases have been described in the literature. A recent case induced us to conduct a systematic search for deaths in hotels in the autopsy reports of the Institute of Legal Medicine in Giessen for the period from 1968 to 2009. This search yielded 22 evaluable cases in which persons had been found dead or had died in hotels. Data evaluated in the study were sex and age of the deceased, reason for the stay in the hotel and cause of death. Among the deaths, 18 were males and 4 females and the average age was 41 and 40 years respectively. 6 of the male guests had died from a natural and 10 from a non-natural cause. In the remaining two cases, the cause of death could not be determined, but as there was no evidence that another party had been involved, the cases were not further investigated. Of the 4 female guests, 3 had died of a natural cause; in one case, the cause of death remained unclear even after morphological and toxicological investigations. Surprisingly, a third of the men were found to be temporarily living in hotels due to social circumstances. This was not true for any of the women. Our retrospective analysis is based on a comparatively small number of deaths in what were mostly hotels in small to medium-sized towns. Interestingly, the gender ratio of 18:4 for deceased men and women was significantly higher than the usual gender ratio of 2:1 found for forensic autopsies. To be able to draw further conclusions, a greater number of cases would have to be analysed, for example by recruiting additional case files from other institutes of legal medicine. This would also open up the option of investigating possible regional variations.

Investigative strategy for the forensic detection of sperm traces.

In a retrospective study, the results from 786 samples of alleged sexual assaults during a 5-year period were evaluated. Of the samples, 758 were from female victims and 28 were from male victims. The material examined during this 5-year period consisted of 561 cotton swabs with swabs taken from the genitals, mouth, anus, or skin surface. In addition, textile products were examined 191 times, paper products 23 times, and other evidentiary materials 11 times. The acid phosphatase (acP) test was performed as a preliminary test for all samples, followed by microscopy after Baecchi staining. DNA analysis was performed on 74 samples following individual court orders. The retrospectively evaluated results from this period indicate that additional tests for the detection of sperm on textiles and paper products are dispensable after a negative acP test. This is different for genital swabs, since sperm could be found microscopically in 3% of cases with a negative acP test, and DNA analysis was also successful. However, an individual investigative strategy has to be determined for each case, as, depending on the structure of the case, the evidence of male DNA on a female victim, or on her clothes, for instance, can also have evidentiary value without microscopic proof for sperm.

Accidental fatal ingestion of colchicine-containing leaves--toxicological and histological findings.

A 65 year old woman had collected some plant leaves, cooked them in water and ate this mash with honey. A few hours after consumption first symptoms of intoxication like sickness, stomach aches and diarrhoea appeared. Her condition deteriorated, she was admitted to hospital, became comatose and finally died due to a multiorgan failure. The plants she had collected were identified as autumn crocus (Colchicum autumnale). Colchicine-concentrations detected in blood samples (HPLC/DAD) taken in hospital approximately 24 h after ingestion were 50 microg/l, in post-mortem femoral blood 65 microg/l colchicine were found (toxic range: >24 microg/l). Also all tested organs contained equally high colchicine levels. Histological examination of the liver showed diffuse vacuolization in the cytoplasma of hepatocytes. Possibly due to the relatively short survival time, only isolated mitotic structures were found within the epithelium of the colon.

Oxalate-crystals in different tissues following intoxication with ethylene glycol: three case reports.

Three alcoholics (62 years, 47 years, 83 years) died between 11 and 18 h after ingestion of ethylene glycol (EG). One person committed suicide. Observed symptoms of intoxication were seizures, respiratory depression, arrhythmias and hypotonia. All died in hospital after failed attempts at resuscitation, one person did so after an 11h dialysis treatment. EG was detected in blood in concentrations of between 1 and 3mg/L (toxic range: >0.3mg/L). One case presented a blood alcohol concentration (bac) of 1.14 per thousand. Further toxic substances were not found. Using special staining techniques, oxalate crystals were found in samples from the kidneys, explaining renal failure, and in the medial layer of cerebral vessels.

Philemon and Baucis Death? Two cases of double deaths of married couples.

When two human corpses are found in temporal and locational context the assumption of a non-natural cause of death is close at hand. Suicide, extended suicide, homicide or accident (particularly with carbon monoxide) come to mind. When, however, a natural cause of death emerges for both after autopsy and further examinations, this provokes the question whether this incidence is coincidental. In our two presented cases, a married couple each was found dead together. In both cases, the wife needed nursing and was being cared for by a husband who died of cardiac disease shortly before the wife died. In one case, the wife died of acute uncompensated chronic congestive heart failure. In the other case, the cause of death of the wife was hypovolemic shock due to acute gastrointestinal bleeding from recurrent gastric mucosal erosion. It is to be discussed for both cases whether, given the pre-existing illness, the acute stress of the situation in view to the husbands' death may at least have favored the occurrence of death and may, thus, have led to the criminologically conspicuous situation of finding.

Fetal and early post-natal development of the human spleen: from primordial arterial B cell lobules to a non-segmented organ.

Immunohistological analysis of 31 human spleens from the 11th week of gestation to the early postnatal period suggested that fetal organ development may be preliminarily divided into four stages. At stage 0 the organ anlage contained erythrocyte precursors, few macrophages and almost no lymphocytes. Fetal spleens of stage I exhibited arterial vascular lobules and lymphocytes just began colonizing the organ. At stage II, B and T lymphocytes formed periarteriolar clusters. B cell clusters predominated, because B cells aggregated around the more peripheral branches of splenic arterioles, while T cells occupied the more centrally located parts of the vessels. The vascular lobules of stage I and II consisted of central arterioles surrounded by B cells, capillaries and peripheral venules. The lobular architecture slowly dissolved at late stage II when sinuses grew out from the peripheral venules into the centre of the lobule. Interestingly, the B cell accumulations around peripheral arterioles did not represent the precursors of follicles, but apparently persisted as periarteriolar B cell clusters in the adult splenic red pulp, while follicles containing FDCs developed at late stage II from B cells in direct contact to T cell clusters around larger arterial vessels. At stage III before birth the lobular architecture was no longer recognized. The chemokine CXCL13 was already present in vascular smooth muscle and adjacent stromal cells at stage I before B cells immigrated. CCL21, on the contrary, was only demonstrated in fibroblast-like cells supporting T cell clusters from stage II onwards.

[Atypical "body packing syndrome"--a case report]. / Atypisches "Bodypacking-syndrom"--ein Fallbericht.

A case of ingested cocaine is reported in which death must be classified as body packer syndrome although both the temporal relationship and the number of packets were atypical. The deceased, a consumer of hard drugs who smuggled for his own use, was found in his flat. He was resuscitated and survived for another four days in hospital. Only four intact drug packages were found in the upper gastro-intestinal tract. The concentrations of cocaine in blood and organs were relatively low but in a potentially lethal range. The case is presented, and its particularities as well as the option of induced vomiting as a way of preventing the fatal outcome are discussed.

[The death of Kaspar Hauser (17 Dec 1833)--assassination, suicide or self-inflicted injury?]. / Todesfall Kaspar Hauser (17.12.1833)-- Attentat, Suizid oder Selbstbeschädigung? Rechtsmedizinische Betrachtungen.

The death of Kaspar Hauser is described taking present medicolegal and criminological knowledge into account, the main question being whether the injury was self-inflicted, homicidal or suicidal. In spite of a critical retrospective analysis this question cannot be answered with sufficient certainty even from our modern perspective. It seems unlikely that the stab to the chest was inflicted exclusively for the purpose of self-damage, but both a suicidal stab and a homicidal act (assassination) cannot be definitely ruled out.

Pathogenesis of conjunctival petechiae.

Conjunctival petechiae from 15 cases (cause of death: different natural and unnatural) were analysed using confocal laser scanning microscopy (CLSM) in order to visualize the kind of the damage within the vessel wall (diapedesis versus rhexis). The pathomorphological findings with multiple ruptures of vessels appearing to be filled to bursting point define the conjunctival petechiae as a rhexis-haemorrhage.

[Deaths in preschool and school age--a retrospective analysis from a medicolegal point of view]. / Todesfälle im Vorschul- und Schulalter--eine retrospektive Analyse aus rechtsmedizinischer Sicht.

At the Department of Legal Medicine in Giessen all forensic autopsies from the years 1990 until 2001 were investigated under the aspect of "death in preschool and school age between 3 and 16 years of age." Out of 69 deaths 19% were due to a natural and 81% to an unnatural cause of death. Both groups (3 to 6 and 7 to 16 years of age) were analyzed retrospectively with regard to age and circumstances of death and compared with the literature. The purpose of the differentiating evaluation is to furnish ideas how to prevent violent deaths of children.

Munchausen syndrome by proxy (MSBP): an extreme form of child abuse with a special forensic challenge.

Munchausen syndrome by proxy (MSBP) is a special form of child abuse in which an adult repeatedly produces symptoms of illness in a person under his/her care. In most cases the perpetrators are mothers who repeatedly and in different ways produce or feign symptoms of illness in their children in order to obtain medical treatment for them. MSBP is thus a special form of child abuse that is also of importance in the field of forensic medicine and a particular challenge to the medicolegal expert. We report two cases of poisoning with different substances (clozapine and clonidine) detected by toxicological investigations at our Department of Legal Medicine. The relevance of the problem for the medicolegal expert and the importance of an interdisciplinary co-operation are pointed out.

Postmortem in situ diagnosis of pacemakers and electrodes to detect dysfunction.

Cardiac pacemakers usually are very reliable, but sometimes malfunctions of the system occur. We conceived and developed a method to judge the functionality of pacemaker systems in deceased patients. The idea was to verify the hypothesis that more dysfunctions of implanted pacemaker systems go undetected than are detected and corrected. With the aid of a pre-amplifier and a digital storage oscilloscope, pacemaker pulse signals are derived from the surface of the thorax. The derived pulse shape offers information on the functionality of pacemakers and electrodes. Additionally the lead impedance is measured with a test pacemaker and its corresponding hand-held programmer. Synchronization properties can also be assessed with an external test pacemaker. So far 262 pacemakers have been investigated yielding an anomaly rate of 15%, comprising life threatening to annoying malfunctions. These results emphasize the forensic relevance and give reason for a discussion about the natural cause of death in these cases.

Studies of interferences of apomorphine and its metabolites or decomposition products with immunochemical screening tests for legal and illicit drugs after therapeutic doses of apomorphine.

This study deals with the question of whether apomorphine (CAS 314-19-2; e.g. in Ixense) and its metabolites or decomposition products interfere with the specificity of immunochemical screening tests (immunoassays) for legal and illicit drugs. It was the result of the investigations that after the therapeutic use of apomorphine no relevant false-positive screening findings were observed with the CEDIA (cloned enzyme donor immuno assay) and FPIA (fluorescence polarisation immuno assay) tests, which are commonly encountered in drug-screening programs, when using recommended cut-off values for urine.

[Death in the neonatal period and infancy. History of medicine and forensic criminal aspects]. / Tod im Neugeborenen- und Säuglingsalter. Medizinhistorische und forensisch-kriminalistische Aspekte.

From antiquity up to the present time the history of medicine contains innumerable examples of the different attitude of human beings in dealing with the death of children. This is paradigmatically described for the death of neonates and infants, with special consideration of the sudden infant death syndrome (SIDS) and selected forensic-criminalistic aspects. Against the historical background of forensic postmortem examination and forensic paidopathology the development of the autopsy is also outlined.

Simultaneous screening and detection of drugs in small blood samples and bloodstains.

A gas chromatography-mass spectrometry (GC-MS) method is described for the screening and detection of morphine, codeine, cocaine, benzoylecgonine, methylecgonine, cocaethylene, delta-9-tetrahydrocannabinol (THC), 11-nor-9-carboxy-THC (THC-COOH), 11-hydroxy-THC (11-OH-THC), amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymetamphetamine (MDMA) and N-methyl-1-(3,4-methylenedioxyphenyl)-2-butanamine (MBDB) in small blood samples and bloodstains using solid phase SPE columns and a pipetting robot (Gilson Aspec XL). The detection limits are in the order of 1.62-4.10 ng/50 microl spot (amphetamines), 0.15-0.82 ng/50 microl spot (cannabinoids), 1.67-4.70 ng/50 microl spot (cocaine and derivatives) and 4.53-4.91 ng/50 microl spot (opiates) and the correlation factors are between 0.9957 and 0.9999. The method has proven useful in forensic cases with only small sample volumes or bloodstains.

[Cadaver mix-up--an avoidable problem?]. / Leichenverwechslung--ein vermeidbares Problem?

Depending on local conditions it may happen from time to time that no officer involved in the previous investigation is present during the forensic autopsy. In this case, the post mortem examiner often has to rely solely on written documentation concerning the identity of the deceased. The authors report a case where the body had already been mixed up with another body by the undertaker prior to the inspection by the police. In spite of clear distinguishing characteristics in the written documentation, this led to the wrong body being autopsied. For the post mortem examiner, the only safe way to identify a body seems to be the presence of persons who had known the deceased or of police officers as acknowledging witnesses. If these conditions are not given, other means of safe information on the identity are called for, for example a "police body card" similar to an evidence card.