The assessment of adipocere to estimate the post-mortem interval - a skeleton from the tidelands.

SUMMARY: This paper discusses the discovery of a skeletonized water corpse with hollow bones filled with adipocere found in the tidelands of the river Elbe close to Otterndorf (Wesermarsch, Cuxhaven). Through macroscopic and microscopic methods, the existing adipocere was described. The post-mortem interval was assessed by a comparison of the radiocarbon data and the indications about the preservation of adipocere from the literature. The investigation has shown that the knowledge of post-mortem changes in adipocere within bone structures is still incomplete, especially for the assessment of water corpses with long post-mortem intervals.

[Medico-legal assessment of the ability to undergo imprisonment: a retrospective analysis of larger numbers of cases from Hamburg]. / Die gerichtsärztliche Uberprüfung der Haftfähigkeit: eine retrospektive Analyse grösserer Fallzahlen aus Hamburg.

The medico-legal assessment and preparation of expert opinions on the ability to undergo imprisonment is an important part of the administration of justice. However, statistical data or reports on such examinations are rare. The article therefore presents an analysis of data from the Medico-Legal Service ("Gerichtsärztlicher Dienst") of the City of Hamburg covering the period from 1975 to 2011. Based on a previous study from the early 1970s, the development of such assessment activities and their results were analysed in detail with the help of relevant statistical data. Conclusions can be drawn as to the need for general medical knowledge of experts giving opinions in the field of clinical forensic medicine.

[A special facet of testing the ability to stand trial: home visits by forensic physicians]. / Eine besondere Facette der Prüfung auf Verhandlungsfähigkeit: gerichtsärztliche Hausbesuche.

Home visits by physicians are generally regarded as a characteristic task of general practitioners. However, this form of external medical practice is also performed in the field of forensic assessments. The article presents the data material of the "Gerichtsärztlicher Dienst" (Medico-Legal Service) of the Free and Hanseatic City of Hamburg collected from 1975 to 2012 and analyses the numerical development and contents of external medico-legal examinations. Statistical records and evaluations of medico-legal examinations are a rarity in Germany. The study presented here is the first investigating external examinations of subjects. It focuses mainly on home visits related to criminal proceedings where it is not clear whether the person concerned is able to stand trial. This special type of medico-legal assessment is an essential part of the administration of justice today. As the article shows, there are parallels with the work of the general practitioner not only with regard to the general aspects of home visits, but also concerning their content. A general medical knowledge is indispensible for experts working in the field of clinical forensic medicine.

Haemorrhages into the back and auxiliary breathing muscles after death by hanging.

We describe and discuss haemorrhages discovered in the back and auxiliary breathing muscles of a population of cases of suicidal death by hanging. Intramuscular haemorrhages were present in approximately 30% of the cases. Pre-existing illnesses with an increased tendency to bleed or an anticoagulant medication did not exist; corresponding skin and subcutaneous fatty tissue structures were intact in each case. In cases of death by hanging, the occurrence of muscle haemorrhages of this type may be explained pathophysiologically by the occurrence of increased respiratory exertions and/or seizures during the hanging process. Although the results of our study do not indicate an obligatory autopsy finding, evidence of internal haemorrhaging into the back and auxiliary breathing muscles may be called upon following consideration of differential diagnostic aspects as a further diagnostic indication of vital hanging.

Bowel wall hemorrhage after death by hanging.

We describe and discuss autopsy findings of bowel wall hemorrhage in a study population comprising cases of suicidal death by hanging. Intramural hemorrhages were seen in approximately 12% of the cases examined; no preexisting bowel diseases were found. In hanging deaths with a longer agonal phase, we opine that abdominal congestion during the hanging process provides a viable pathophysiological explanation for bowel wall hemorrhage. Though we are not dealing here with obligatory autopsy findings, the detection of bowel wall hemorrhage might be used as another sign of vital hanging after considering differential diagnostic aspects.

[An extreme case of undoing and posing in a case of murder-suicide. A forensic pathological approach to crime scene investigation]. / Ein extremer Fall von "Undoing" bei einem erweiterten Suizid. Ein rechtsmedizinischer Beitrag zur Tatortanalyse.

A 7-year-old boy was killed by his father by manual strangulation during a murder-suicide. After the killing of the son, the father showed typical "undoing" behaviour: He changed the boy's clothes and laid him down on the bed. Then he placed candles around his head, put pictures of the parents' wedding around him and a crucifix and a picture of the family into his hands. He broke off a rose in a vase next to the bed, lit the candles and took photographs of his dead son. Later he called his wife, threatened to kill the son and finally called the police to confess the murder and to announce his forthcoming suicide.

Laparoscopic cholecystectomy associated lethal hemorrhage.

BACKGROUND AND OBJECTIVES: Blood oozing after cholecystectomy is a rare but potentially life-threatening complication. Recently, 2 patients died from this cause. The deaths resulted in criminal proceedings and medical experts were called in. The objective of this report is to describe their findings and to elucidate preoperatively unknown risk factors of bleeding. METHODS: Medical records, autopsy, and histological examination of the liver, heart, pancreas, spleen, and kidney pertaining to 2 recent cases of laparoscopic cholecystectomy were examined. Current literature on this topic was reviewed. RESULTS: Preoperative risks included renal insufficiency, diabetes mellitus, and cardiopathy. The histological examination, in particular of the gallbladder bed of the liver, disclosed siderosis, inflammation, and fatty degeneration. These factors supported and perpetuated blood oozing. Postoperative ultrasonography and a hemogram might have detected and prevented death. CONCLUSION: Inflammatory alterations, siderosis, and fatty degeneration of the liver are risk factors of postoperative hemorrhage. Autopsy and histological examination can detect those factors. Adequate postsurgical observation is mandatory, especially for patients at risk.

[Fatal chest injury from a shotgun slug: homicide, accident or suicide?]. / Tödlicher Brustschuss mit Flintenlaufgeschoss--Tötungsdelikt, Unfall oder Suizid?

A 78-year-old hunter was found dead beside his raised hide with a gunshot wound to his chest. In the present case, the reconstruction of the shooting event revealed an accident. Disregarding all safety rules, the hunter had placed his superposed rifle-shotgun on the chair and pulled the barrels of the cocked gun towards his body. One of the triggers interlocked with the button of a camping chair's cushion and a shot was fired. Furthermore the morphology of wounds from shotgun slugs is discussed on the basis of the autopsy findngs.

[Suicidal gunshot to the head while driving a car]. / Suizidaler Kopfschuss im fahrenden Pkw.

A severe traffic accident occurred on the German autobahn. According to eye witnesses, the car had changed from the left to the right lane at 160 km/h before crashing into a thicket at full speed. In the car, a sports pistol was found in the footwell of the driver's side. The emergency doctor who performed the external examination of the victim's body found a gunshot wound in the region of the driver's right lower jaw. As the prosecutor released the body without further examination, the family of the suicide asked for an autopsy, which demonstrated a lethal suicidal gunshot to the head; toxicological tests proved a previous consumption of cocaine.

Intracranial arteriovenous malformations presenting as sudden unexpected death: a report of 3 cases and review of the literature.

Intracranial arteriovenous malformations (AVMs) are cerebrovascular abnormalities due to maldevelopment of the regional capillary bed, producing lesions with arteriovenous shunting. AVMs may account for as many as 1% of all sudden deaths; however, case reports in the literature are exceedingly rare. We present 3 cases of sudden death due to hemorrhage of AVM and discuss the literature and the differential diagnosis in cases of sudden death due to intracranial hemorrhage.

Mitral valve prolapse syndrome as cause of sudden death in young adults.

Mitral valve prolapse syndrome (MVPS) is a relatively common disorder of the mitral valve and most cases take a benign clinical course. Only a subset of patients develop severe clinical symptoms such as arrhythmia, insufficiency of the mitral valve or infective endocarditis. As a consequence, sudden death might occur in these patients, thought to be caused by an arrhythmogenic event. By presenting six cases of sudden unexpected death in young female adults, we point at clinical and pathological data from the literature, which are of interest from the viewpoint of legal medicine. The incidence of MVPS in autopsy series has been reported to be about 4-5%, while clinical data hint at an incidence of about 2.5%. The presented cases suggest that even clinically benign cases of MVPS in young adults might result in sudden unexpected death. Such cases are not included in hospital based studies on the topic. This might lead to an underestimation of the fatal risk associated with the disease, even if sudden death might be a rare event in MVPS.

Occurrence of hydrogenases in cyanobacteria and anoxygenic photosynthetic bacteria: implications for the phylogenetic origin of cyanobacterial and algal hydrogenases.

Hydrogenases are important enzymes in the energy metabolism of microorganisms. Therefore, they are widespread in prokaryotes. We analyzed the occurrence of hydrogenases in cyanobacteria and deduced a FeFe-hydrogenase in three different heliobacterial strains. This allowed the first phylogenetic analysis of the hydrogenases of all five major groups of photosynthetic bacteria (heliobacteria, green nonsulfur bacteria, green sulfur bacteria, photosynthetic proteobacteria, and cyanobacteria). In the case of both hydrogenases found in cyanobacteria (uptake and bidirectional), the green nonsulfur bacterium Chloroflexus aurantiacus was found to be the closest ancestor. Apart from a close relation between the archaebacterial and the green sulfur bacterial sulfhydrogenase, we could not find any evidence for horizontal gene transfer. Therefore, it would be most parsimonious if a Chloroflexus-like bacterium was the ancestor of Chloroflexus aurantiacus and cyanobacteria. After having transmitted both hydrogenase genes vertically to the different cyanobacterial species, either no, one, or both enzymes were lost, thus producing the current distribution. Our data and the available data from the literature on the occurrence of cyanobacterial hydrogenases show that the cyanobacterial uptake hydrogenase is strictly linked to the occurrence of the nitrogenase. Nevertheless, we did identify a nitrogen-fixing Synechococcus strain without an uptake hydrogenase. Since we could not find genes of a FeFe-hydrogenase in any of the tested cyanobacteria, although strains performing anoxygenic photosynthesis were also included in the analysis, a cyanobacterial origin of the contemporary FeFe-hydrogenase of algal plastids seems unlikely.

[Premature detachment of the placenta due to kicks to the lower abdomen]. / Vorzeitige Plazentalösung--ausgelöst durch Tritte gegen das Abdomen.

An 18-year-old woman in an advanced stage of pregnancy was admitted to hospital for gynaecological emergency treatment with pain after kicks to the lower abdomen. Premature detachment of the placenta was diagnosed and an immediate Caesarian section was performed. Although the newborn was resuscitated at once by the medical team, it died two days later in the paediatric hospital from multiorgan failure. The autopsy results together with the pathological findings of the palcenta proved the causal context between the kicks, the premature detachment of the placenta and the hypoxia requiring postnatal resuscitation, so that the perpetrator was found guilty.

Mutagenesis of hydrogenase accessory genes of Synechocystis sp. PCC 6803. Additional homologues of hypA and hypB are not active in hydrogenase maturation.

Genes homologous to hydrogenase accessory genes are scattered over the whole genome in the cyanobacterium Synechocystis sp. PCC 6803. Deletion and insertion mutants of hypA1 (slr1675), hypB1 (sll1432), hypC, hypD, hypE and hypF were constructed and showed no hydrogenase activity. Involvement of the respective genes in maturation of the enzyme was confirmed by complementation. Deletion of the additional homologues hypA2 (sll1078) and hypB2 (sll1079) had no effect on hydrogenase activity. Thus, hypA1 and hypB1 are specific for hydrogenase maturation. We suggest that hypA2 and hypB2 are involved in a different metal insertion process. The hydrogenase activity of DeltahypA1 and DeltahypB1 could be increased by the addition of nickel, suggesting that HypA1 and HypB1 are involved in the insertion of nickel into the active site of the enzyme. The urease activity of all the hypA and hypB single- and double-mutants was the same as in wild-type cells. Therefore, there seems to be no common function for these two hyp genes in hydrogenase and urease maturation in Synechocystis. Similarity searches in the whole genome yielded Slr1876 as the best candidate for the hydrogenase-specific protease. The respective deletion mutant had no hydrogenase activity. Deletion of hupE had no effect on hydrogenase activity but resulted in a mutant unable to grow in a medium containing the metal chelator nitrilotriacetate. Growth was resumed upon the addition of cobalt or methionine. Because the latter is synthesized by a cobalt-requiring enzyme in Synechocystis, HupE is a good candidate for a cobalt transporter in cyanobacteria.

[Delayed pericardial tamponade following a stab wound to a branch of the right coronary artery]. / Aussergewöhnlicher Verlauf einer Herzbeuteltamponade nach Stichverletzung eines Astes der rechten Koronararterie.

A 45-year-old man was attacked with a knife and suffered multiple stab wounds to the chest and abdomen. After surgical treatment and hospitalization for 9 days he was discharged in a stable condition. The following day he was found dead in his apartment. The autopsy revealed a pericardial tamponade caused by acute bleeding from an injured branch of the right coronary artery. This case shows that life-threatening late complications in patients with penetrating cardiac wounds may occur despite an initially uneventful course.

[Intramuscular bleeding in deaths from an internal cause: forensically significant differential diagnosis between external trauma and hemorrhages occurring during agony]. / Intramuskuläre Blutungen beim Tod aus innerer Ursache. Forensisch bedeutsame Differentialdiagnostik zwischen ausserer Gewalteinwirkung und agonal entstandenen Einblutungen.

Five cases of death from an internal cause are described in which bleeding into the muscles of the neck, the region of the shoulder girdle, the back of the thorax and partly the arms occurred during agony. As the cause of death was unclear at first and a violent crime could not be ruled out, a forensic autopsy was ordered in the course of which hemorrhages were detected which raised the differential diagnostic question whether extravasation might have been caused by an impact of blunt force. However, thorough investigation of the macroscopic and especially the microscopic structure of the lesions provided clear evidence that all the hemorrhages were due to internal causes. The pattern of these muscular lesions suggests intensified breathing with dyspnea leading to ruptures of the accessory respiratory muscles. Intramuscular bleedings of this type are a well-known phenomenon in legal medicine in connection with death by drowning, but have not been described in the medicolegal literature in cases of natural death from an internal cause so far.

LexA regulates the bidirectional hydrogenase in the cyanobacterium Synechocystis sp. PCC 6803 as a transcription activator.

The bidirectional NiFe-hydrogenase of Synechocystis sp. PCC 6803 is encoded by five genes (hoxEFUYH) which are transcribed as one unit. The transcription of the hox-operon is regulated by a promoter situated upstream of hoxE. The transcription start point was located at -168 by 5'Race. Several promoter probe vectors carrying different promoter fragments revealed two regions to be essential for the promoter activity. One is situated in the untranslated 5'leader region and the other is found -569 to -690 nucleotides upstream of the ATG. The region further upstream was shown to bind a protein. Even though an imperfect NtcA binding site was identified, NtcA did not bind to this region. The protein binding to the DNA was purified and found to be LexA by MALDI-TOF. The complete LexA and its DNA binding domain were overexpressed in Escherichia coli. Both were able to bind to two sites in the examined region in band-shift-assays. Accordingly, the hydrogenase activity of a LexA-depleted mutant was reduced. This is the first report on LexA acting not as a repressor but as a transcriptional activator. Furthermore, LexA is the first transcription factor identified so far for the expression of bidirectional hydrogenases in cyanobacteria.

Influences on tocopherol biosynthesis in the cyanobacterium Synechocystis sp. PCC 6803.

To elucidate influences on the tocopherol biosynthesis in cyanobacteria, wild type and mutant cells of a putative methyltransferase in tocopherol and plastoquinone biosynthesis of Synechocystis sp. PCC 6803 were grown under different conditions. The vitamin E content of cells grown under different light regimes, photomixotrophic or photoautotrophic conditions and varying carbon dioxide supplies were compared by HPLC measurements. The tocopherol levels in wild type cells increased under higher light conditions and low carbon dioxide supply. Photomixotrophic growth led to lower vitamin E amounts in the cells compared to those grown photoautotrophically. We were able to segregate a homozygous deltasll0418 mutant under photoautotrophic conditions. In contrast to former suggestions in the literature the deletion of this gene is not lethal under photomixotrophic conditions and the influence on tocopherol and plastoquinone amounts is diminutive. The methyltransferase encoded by the gene sll0418 is not essential either for tocopherol or plastoquinone synthesis.

[Pneumatic spaces of the zygomatic arch (zygomatic air cell defect) on pantomograms--an aid for age determination and identification]. / Pneumatisationen des Jochbogens ("Zygomatic Air Cell Defect") auf Panoramaschichtaufnahmen--ein Hilfsmittel zur Identitätsbestimmung und Altersschätzung.

The analysis of panoramic radiographs of the jaws for forensic purposes is well established. The dental findings on the radiographs give valuable information concerning the identity and possible age. Panoramic radiographs also depict the zygomatic arches. Pneumatized spaces of the temporal bone's zygomatic arch process are asymptomatic variations, entitled "zygomatic air cell defect" (ZACD). Data on ZACD prevalence might support the current forensic-odontologic practice in the fields of identification and age assessment. The authors analyzed 6 studies subjected to evaluate ZACD on panoramic radiographs. The out-patients were subjected to systematic radiography prior to treatment planning in specialized dental or maxillofacial surgery clinics. The age of the 7870 patients varied between 6 and 97 years. ZACD was found in 169 patients (prevalence: 2.32%; female: 56.12%, male: 43.9%). Most ZACD were unilateral (70%). In these studies no ZACD occurred in children younger than 7 years of age. There was no statistically significant difference concerning ZACD prevalence in the sub-groups of children aged 9 to 13 vs. 14 to 17 years. This review demonstrates the prevalence of ZACD on orthopantomograms. The prevalence of this finding in the investigated children does not differ from the prevalences reported for adults, and is low in general. The presence of ZACD in persons might be valuable for the identification of humans or human remains and for age estimation in addition to other physical and dental findings.

[Assignment of a bite-mark on the victim's skin to the dentition of the perpetrator by means of anomalies in the number and position of the frontal teeth]. / Zuordnung einer Bissmarke an der Haut des Opfers zum Gebiss des Täters durch Nachweis von Anomalien der Stellung und Zahl der Frontzähne.

This report is about a bite mark on the breast of a female corpse. The woman had been killed by ligature strangulation at the age of 76 years. The investigation of the dental casts of a suspected man showed some anomalies in the dentition and orthodontic variations. A comparison of the bite mark with these anomalies demonstrated the correspondence of several details. Consequently, the probability that the suspect was responsible for the bite mark was regarded as being very high. During the further investigations the suspect admitted the offence including the bite injury to the breast. The authors emphasize the importance of an exact photographic documentation as an indispensable prerequisite for an odontological comparison.