[Neonaticides in Hamburg, Germany, from 1998 to 2008]. / Tötung von Neugeborenen - Neonatizide in Hamburg von 1998 bis 2008.

In the analyzed period from 1998 to 2008, the autopsies performed at the Hamburg Institute of Legal Medicine included 13 cases in which an investigation for neonaticide had been initiated by the public prosecutor. The killed neonates showed a nearly equal distribution between both sexes. The most common method of neonaticide was suffocation. Most of the perpetrators were young, unmarried primipara with an average educational background. Almost all of them were suffering under psychological stress and had negated their pregnancy. In most cases, birth and neonaticide happened alone in their flat, and there was no medical attendance in any case. In the cases brought to court the women were charged with manslaughter (Section 212 German Criminal Code) and those found guilty were always granted a mitigated sentence pursuant to Section 213 Criminal Code.

[Injuries of the female genitalia in cases of sexual assault]. / Verletzungen weiblicher Geschlechtsorgane nach sexualisierter Gewalt.

Sexual violence is a global problem that particularly affects women and children. A retrospective analysis of 390 clinical-forensic examinations and 120 autopsies regarding injuries of the female genitalia in cases of sexual violence was performed. In the majority of cases no injuries of the female genitalia were found. Autopsy cases showed significantly more (and more serious) injuries of the genitalia than clinical forensic examinations (43 % vs. 25 %; p = 0.0004). Predominantly found were injuries of the external anogenital area, mostly tears or soft tissue lesions. In the current literature, data regarding the rate of injuries in victims of sexual violence vary strongly and their comparability is limited. Regarding the reconstruction of an offence, a forensic examination with an appropriate documentation of the injuries is evidently crucial.

[Relation of external biometric parameters to health risk and mortality--analysis and evaluation of different measurement methods and study results]. / Das Verhältnis ausserer Körpermasse zum Erkrankungsrisiko und zur Todesursache--Analyse und Bewertung unterschiedlicher Messmethoden und Studienergebnisse (I).

In clinical practice diagnoses can be found which are partially based on body measurements. By measuring body height and body weight the patient is categorised, for example by Body-Mass Index (BMI), in different adipose grades. Different diseases are associated with specific biometric parameters. Abdominal adiposity measured by waist circumference correlates with the risk of colon carcinoma and is one diagnostic criteria of the metabolic syndrome. An unhealthy waist-hip ratio (WHR) can cause a higher risk of a cardiovascular disease and dementia. By combining body measurement with cause of death found during the medicolegal autopsy, clinical relevant correlations can be uncovered. Research in medical databases (e.g. PubMed) was carried out to find studies showing possible associations between body measurements, their indices and morbidity or causes of death. This article is a selective survey of these published studies, current guidelines and the German Institute for Standardisation - Norm (DIN-Norm). We give a wide thematic overview and select relevant parameters, which should be taken during medico-legal autopsies in future. The ascertainment of those parameters and their adjustment with the findings of the medico-legal autopsies can be a key to finding predictors of history of disease and relevant morbidity risks in the institutes of forensic medicine. Such findings are very important in the assessment of risk for living patients and necessary preventive actions. Beside the measurement of waist and hip circumference mentioned in specific clinical guidelines in Germany, we suggest, after analysing the parameters, to measure the thickness of the subcutaneous fat on the anterior chest and the thigh circumference as well.

Abusive head trauma in children: a comparison of male and female perpetrators.

OBJECTIVE: To evaluate the effect of perpetrator gender on victim presentation and outcomes, and perpetrator legal outcomes for abusive head trauma (AHT). METHODS: We performed a retrospective chart review of AHT cases from 1998 to 2008. Patient clinical data and information regarding perpetrator legal outcome was obtained. Relationship of brain injury and retinal hemorrhages (RHs) and differences in categorical variables of perpetrator gender were compared by using Fisher's exact test. Differences in continuous variables between perpetrator gender were compared by using the Mann-Whitney Test. RESULTS: There were 34 cases of AHT with identified perpetrators, 17 of each gender. Mean age of the victims was 9.4 months (SD: 7.8). Thirty-two (94%) had intracranial hemorrhages, 14 (41%) had both primary and secondary brain injury, 28 (82%) had RHs, and 6 (18%) died. The severity of RH was related to the severity of brain injuries (P = .01). The median age for female perpetrators (34 years) was higher than that for males (27 years; P = .001). Six categorical variables were associated with male perpetrator gender: acute presenting symptoms of cardiopulmonary or respiratory arrest (P = .025), worse clinical outcome (P = .012), neurosurgical intervention (P = .037), death (P = .018), perpetrator confession (P = .0001), and conviction (P = .005). CONCLUSIONS: There were significant perpetrator gender differences of AHT in children. Male perpetrators were younger and more likely to confess and be convicted. Victims of male perpetrators had more serious acute presentations and neurosurgical intervention and suffered worse clinical outcomes.

Medico-legal autopsies in Denmark.

INTRODUCTION: At 2.7% in 1970, the Danish medico-legal autopsy frequency was lower than recent frequencies observed in the Nordic countries (4-24%). The aim of this study was to analyse trends in the number and frequency of Danish medico-legal autopsies. MATERIAL AND METHODS: Data were collected from the computerized archives in the Danish departments of forensic medicine, Statistics Denmark and the Danish National Board of Health. RESULTS: During the 1996-2005 study period, a total of 14,990 medico-legal autopsies were performed. This yielded a medico-legal autopsy frequency of between 2.4% and 2.8%. Our results revealed a certain constancy in the number of medico-legal autopsies and frequency of autopsy with regard to manner of death, sex and number, but we also observed changes in the age composition which involved a decrease in the proportion of young (20-39 years) and an increase in the proportion of middle-aged persons (40-59 years). CONCLUSION: Denmark has a lower autopsy frequency than other Nordic countries and this may constitute a problem for quality of death-statistics and research based on autopsy results. If the patterns in medico-legal autopsy frequencies continue, a decrease in the number of medico-legal autopsies is to be expected. As a consequence, education and training of forensic pathologists may be impaired.

[Differential diagnostics of stomach contents showing blue discoloration]. / Zur Differentialdiagnose des blau Verfärbten Mageninhalts.

A 42-year-old man evidently had died from an intoxication. On the basis of the findings at scene it was primarily assumed that the man had ingested a larger quantity of an ethylene glycol-containing antifreeze for suicidal purposes. The man was said to have had an alcohol problem and did not only consume drinking alcohol, but also other alcoholic liquids. At autopsy, a bluish liquid with an aromatic smell was found in the oesophagus and stomach. However, toxicological analyses did not furnish evidence of ethylene glycol--as expected--but a potentially fatal concentration of ethanol (blood alcohol concentration 4.01 per mille). The blue colour (patent blue C.I.42051) came from a liquid used in the wind-screen washer system in winter, which now contains ethanol (denatured with 2-butanone) instead of ethylene glycol. The results of the toxicological findings including the analysis of congener alcohols and the differential diagnostics of blue-coloured stomach contents are discussed.

[Suicide in children, youths and young adults]. / Suizide von Kindern, Jugendlichen und Heranwachsenden.

Suicides among children and youths are tragic events. The suicide cases of children, youths and young adults examined between 1995 and 2009 at the Institute of Legal Medicine of the Hanover Medical School were retrospectively analyzed. Altogether, 54 suicides among children, youths and young adults (37 males, 17 females; median age 17.5 years) were evaluated. The suicide victims were predominantly male (68.5%). The vast majority used "hard" methods such as hanging, jumping from a height or being run over by a train. In seven cases (13.0%) psychiatric disorders were known. Seven victims (13.0%) left a suicide note. Suicide was most frequently (40.7%) committed in the open air (40.7%). In addition, the evaluation shows that at the time of committing suicide more than 40% of the youths and adolescents, in whom a chemical toxicological examination was performed, were under the influence of alcohol, medical and/or illegal drugs.

[Superimposition of ante- and post-mortem photographs of tattoos as a means of identification--a case report]. / Superimposition ante- und Postmortaler Bilder von Tätowierungen zur Identitätssicherung - ein Fallbericht.

With the rising number of tattooed people tattoos have become increasingly important for the identification of unknown corpses. Tattoos can be helpful in both phases of the identification process, either by providing clues to the identity of an unknown person or body or as a means of verifying a postulated identity. In the presented case, an ante-mortem photograph of a tattoo was available although it was of poor quality. The respective skin region of the body was photographed from the same angle as the tattoo on the ante-mortem photograph. When superimposing the two photos, the tattoos were found to match and the identity of the body could be verified.

[Identification of an unknown body by means of osteosynthesis material]. / Identifizierung einer Unbekannten Leiche Anhand von Osteosynthesematerial.

The present case describes the identification of an unknown corpse recovered from water by means of two osteosynthesis plates with serial numbers. This method of identification is compared with the pros and cons of other possibilities of identification using medical findings. Although in Western Europe osteosynthesis material is normally removed some months after the operation, autoptic exposure of a suspicious bone may occasionally allow valid, fast and convenient identification of the body, especially if osteosynthesis material with different serial numbers was used.

How can we reduce the number of coroner autopsies? Lessons from Scotland and the Dundee initiative.

Currently the medicolegal dissection rate for England and Wales is 22% (110,000 coronial autopsies for 500,000 deaths per annum), yet there is a general lack of evidence about the utility of and justification for such a high level of activity, which is between double and triple the rate in other jurisdictions. The government is currently consulting on how to reduce the numbers, and the Coroners and Justice Act 2009 is permissive of external examinations as an alternative to dissections. We describe the philosophy and practice of the Scottish system of postmortem external examinations, and the 20-year experience of a local initiative to maximize use of such external examinations. Currently our regional medicolegal dissection rate is 6%, which if applied to England and Wales would reduce the number of dissections from 110,000 to 30,000 per annum, with all of the social, resource and management implications. While the autopsy is an important tool in modern death investigation, an almost automatic recourse to it is inappropriate. In our view external examinations are not only cost-effective but also a necessary element in any death investigative system which wishes to strike an appropriate balance between intrusion by the state and the rights of the bereaved.

The medico-legal investigation of sudden, unexpected and/or unexplained infant deaths in South Africa: where are we--and where are we going?

Sudden Infant Death Syndrome (SIDS) has been reported to be the leading cause of death in infants under 1 year of age in many countries. Unfortunately, a paucity of published research data exists in South Africa, with regard to the incidence of and investigation into the circumstances surrounding Sudden Unexplained Deaths in Infants (SUDI) and/or SIDS. Currently, even though most academic centers conform to a protocol consistent with internationally accepted standards, there exists no nationally accepted infant death investigation protocol in South Africa. It is the aim of this study to review the current practice of infant death investigation in two representative but geographically and demographically distinct centers. Retrospective case audit over a five-year period (2000-2004) was conducted at two large medico-legal mortuaries in Pretoria (Gauteng) and Tygerberg (Cape Town). Case files on all infants younger than 1 year of age were reviewed. The outcome measures included number of deaths, demographic details and the nature and final outcome of the post mortem examinations. A total of 512 cases were identified as possible SIDS cases and of these, 171 was classified as SIDS. The study showed marked inter-case and inter-divisional variation in terms of the investigation of infant deaths at the two institutions. It is envisaged that this study will focus attention on the current lack of usable data regarding sudden/unexplained/unexpected infant deaths in South Africa, and aid in the formulation and implementation of a practical (yet internationally accountable) infant death investigation protocol, which could facilitate comparisons with other countries and initiate further structured research in this field.