[Autopsies at the boundary between pathology and forensic medicine : Suggestions for interdisciplinary cooperation]. / Obduktionen im Grenzbereich zwischen Pathologie und Rechtsmedizin : Vorschläge zur interdisziplinären Kooperation.

There are many differences between forensic medicine and pathology but also many similarities, as they share a common basis. In this article the characteristics of the forensic autopsy and it's legal foundations are presented. Furthermore, possibilities are discussed for a cooperation between forensic medicine and pathology to increase the rate of autopsies. This could contribute to the legal certainty, to the quality assurance and to the training of physicians.

[Forensic medicine and the overlap with pathology]. / Zur Rechtsmedizin und ihren Berührungspunkten mit der Pathologie.

Forensic medicine incorporates research, teaching and professional service. In the routine practice this encompasses interdisciplinary cooperation with physicians, natural scientists and the legal profession. Lectures in forensic medicine include the correct performance of an external examination of corpses, which every physician must be capable of, just as medical questions and the evidential documentation of injuries. Clinical forensic medicine encompasses the examination and documentation of living victims of physical and/or sexual violence. For further training to become a specialist for forensic medicine it is mandatory to undertake a 6-month training period in pathology. Fatalities with an unclear or unnatural manner of death must be registered with the police. On suspicion of third party involvement the public prosecutor will request a legal autopsy, which is carried out and documented by two physicians in accordance with the penal code. Imaging procedures are standard for an autopsy. Extensive samples are taken for additional testing, such as toxicological and molecular biological investigations.

[Value of postmortem computed tomography in comparison to autopsy]. / Prospektive Untersuchung zur Wertigkeit der postmortalen Computertomographie im Vergleich zur Autopsie.

PURPOSE: To assess the diagnostic value of postmortem computed tomography (CT) in comparison to autopsy. MATERIALS AND METHODS: Twenty-seven cadavers were examined by sequential cranial CT and helical CT through the neck, thorax and abdomen and subsequently underwent an autopsy with histomorphologic examination of the pathologic specimens. The findings of CT, autopsy and histology were registered and compared by three radiologists and one specialist for forensic medicine, using a data entry form. RESULTS: In 19 of 27 cases, the findings explaining the cause of death were concordant for CT and autopsy. Intracranial, intraspinal and intracardiac gas accumulations (n = 12) were registered by CT alone. The detection of skull fractures was equal for both methods (n = 3). CT showed diagnostic problems in the assessment of pneumonic infiltrations (n = 16) and pulmonary edema (n = 21). CONCLUSION: CT is a useful and complementary method to autopsy.

[The identification of unknown corpses by x-ray comparison]. / Identifizierung unbekannter Leichen durch Röntgenbildvergleich.

Between 1987 and 1993, 30 unknown bodies were identified by means of pre- and postmortem radiographs at the Forensic Institute in Mainz. Our experience indicates that radiological identification comprises a useful, rapid and cheap method, at least as valuable as dactyloscopy or odontological comparisons. The ages of available radiographs were up to 25 years; the most suitable regions are the skull (11), pelvis and lumbar spine (6), lower femur and knee (5) and distal leg with the ankle joint (5). In respect of the problem of objectifying the probability of identity, possibilities for solutions are shown.

[The incidence, age dependence and sex distribution of the calcaneal spur. An analysis of its x-ray morphology in 1027 patients of the central European population]. / Häufigkeit, Altersabhängigkeit und Geschlechtsverteilung des Fersensporns. Analyse der Röntgenmorphologie bei 1027 Patienten der mitteleuropäischen Population.

In 1027 lateral radiograms of the ankle in a Caucasian population, 161 plantar and/or dorsal calcaneal spurs (15.7%) were diagnosed. Plantar spurs were more common than dorsal spurs (11.2 and 9.3% respectively). Prevalence of both spurs increases considerably with the rising age. Dorsal spurs appear slightly earlier than plantar spurs. The spur frequencies are similar in left and right feet. The plantar spurs were significantly (p < 0.0001) more common in women than in men in general, while dorsal spurs were more frequent in men than in women up to the age of 70. The previously reported higher frequencies of plantar and dorsal calcaneal spurs in women than in men are probably a result of a disproportionally higher number of women in higher age in the groups studied. In forensic medicine, calcaneal spurs provide evidence for identity and age of unknown corpses, and to certain extend their profession, physical activities and constitution during life.

[Computerized tomography of the epiphyseal union of the medial clavicle: an auxiliary method of age determination during adolescence and the 3d decade of life?]. / Die computertomographisch bestimmte Ausreifung der medialen Klavikulaepiphyse--eine additive Methode zur Altersbestimmung im Adoleszentenalter und in der dritten Lebensdekade?

PURPOSE: To establish a reference population for the stages of epiphyseal union of the medical clavicle determined by CT. MATERIAL AND METHODS: Retrospectively, the thoracic CTs of patients under 30 years of age were reevaluated. Basic conditions were the lack of a bone development disorder and a sufficient assessment of the medial clavicle in a bone window setting. The stages of epiphyseal union were categorized as follows: Stage 1 refers to nonunion without ossification of the epiphysis, Stage 2 to nonunion with a separate and ossified epiphysis, Stage 3 to partial, and Stage 4 to complete union. RESULTS: Up to now, 279 individuals could be included in the study. Stage 1 was observed till age 16, Stage 2 occurred from ages 13 through 22, Stage 3 was found from ages 16 through 26. Stage 4 was first noted at age 22, and in 100% of the sample at age 27. CONCLUSIONS: CT is well suitable to determine the stages of epiphyseal union of the medial clavicle. It may become a generally accepted method of age identification during adolescence and the 3rd decade of life. The presented data serve as a reference population at least for white Europeans.

[1H-MR spectroscopic imaging: an approach to evaluating alcohol breakdown in the brain]. / 1H-MR-spektroskopische Bildgebung: ein Ansatz zur Evaluierung des Alkoholabbaus im Gehirn.

The local alcohol concentration in the human brain was determined in 10 cases using MR spectroscopic imaging. Therefore 7 subjects with an average blood alcohol concentration of 0.8/000 were examined after oral intake of alcoholic beverages. Varying alcohol concentration was found intracranially which was recorded spectroscopically w.r.t. time. Relatively high ethanol concentrations were determined in the cerebellum as well as in the ventricular system. Contrary to this, lower concentrations were found in the regions of grey and white matter.

Identification of unknown dead bodies by X-ray image comparison of the skull using the X-ray simulation program FoXSIS.

The aim of the study was to improve the objectivity of X-ray image comparison for the identification of unknown dead individuals. CT-data were collected for 30 macerated skulls. An already presented computer program which uses CT data to establish virtual X-ray images was used to obtain X-rays with different beam angulations simulating rotation, dorsal flexion, and ventral flexion. Specific parameters were measured on the simulated images. The frontal sinus reveals the highest variability not only between the individual skulls but also within an individual skull in different positions. The most consistent parameters with respect to different positions were the skull breadth, the biorbital breadth and the bizygomatic breadth. In a blind study, three out of 24 skulls could clearly be identified just by measured distances although the positions were different and unknown to the investigator. The dimensions of the frontal sinus do not correlate with the other skull parameters (analysis of covariance). Based on the presented results, we propose a method that will calculate the probability of identity. The presented results demonstrate that the comparison of X-ray images can be undertaken in an objective way by quantifying the probability of identity even when the comparative images were made under different conditions.

Computer-assisted simulation of conventional roentgenograms from three-dimensional computed tomography (CT) data--an aid in the identification of unknown corpses (FoXSIS).

A computer simulation program (Forensic X-ray Simulation and Identification System, FoXSIS) is presented. FoXSIS calculates conventional X-ray summation images using any scanning parameters from three-dimensional CT data records. All those parameters decisive for X-ray morphology are freely selectable for realistic simulations: focus-object distance, object-film distance, centering of the X-ray beam, the location of the object in the patch of rays, brightness and contrast, as well as parallel and central projection. In addition, distance and angle measurements, as well as enlargements of details are possible. The program may be expected to help in the identification of unknown corpses now, and even more in the future on account of the increased use of clinical computed tomographies.

Estimation of sex on the basis of radiographs of the calcaneus.

Lateral and anteroposterior radiographs of the ankles of 800 Central Europeans aged 20 to 79 were analyzed with regard to sexual dimorphism. All the distances, but not the angles, of the calcaneus were much larger in males than in females. Approximately 80% of the study sample could be sexed correctly by classifying all specimens greater than 86.0 mm in length as male and those less than 86.0 mm as female. The prevalence of os tibiale externum was 8.0 and 2.6% and the prevalence of plantar heel spur was 16.3 and 6.5% (increasing with age) for males and females, respectively, being significantly more frequent in females. On the other hand, the bone island frequencies were 9.1% in males and 4.8% in females. Our study suggests that radiographs of the ankle are a convenient, rapid, cheap and non-invasive means for estimating sex.

Identification of an unknown corpse by means of computed tomography (CT) of the lumbar spine.

For the first time, a case is described in which an unknown corpse is identified by the comparison of antemortem and postmortem computed tomographic (CT) images. A posterolateral disc herniation at L5-S1 on the right side, Schmorl's nodes and a lucency in the ilium were found in identical locations in each case. Additionally there were characteristic morphological similarities in the vertebral bodies, spinous processes, transverse processes and neural arches. In CT identification, as in conventional radiographic identification, one must try to reproduce comparable scanning conditions and images because apparent differences in the roentgenological morphology can occur as a result of different gantry angles or slice thicknesses.

[Delayed aortic rupture following a fall from an examination couch. Clinical and forensic aspects]. / Zweizeitige Aortenruptur nach Sturz von Untersuchungsliege. Klinische und forensische Aspekte.

BACKGROUND: Physicians frequently have to face an investigation of their work from a judicial point of view. Due to these proceedings the number of cases when they are reproached with malpractice is increasing. CASE REPORT: We report the rare case of a 76-year-old female patient who fell from a 68 cm high couch after a sedative was applied during gastroscopical examination. She died 24 hours after the incident. Forensic necropsy revealed a delayed aortic rupture as the cause of death. The preliminary proceedings against the physician involved for culpable homicide by criminal negligence were suspended after he paid a fine. The possible legal consequences under German law for physicians involved in such cases are discussed as well as strategies to avoid them. CONCLUSION: Physicians who are under investigation for malpractice should act carefully. They are advised to seek professional help at an early stage of preliminary proceedings. A public trial should be avoided if possible.

[Viewing the criminal site in unusual cadaver evidence: concealment, identification, determining time of death and reconstruction]. / Tatortbesichtigung bei aussergewöhnlichen Leichenfunden: Bergung, Identifizierung, Todeszeitbestimmung und Rekonstruktion.

The three cases presented here (Place of finding: bath tub.: [a] 19 year old, female, stabbed to death, detection six months pm, nearly airtight room--silicon rubber; [b] 56 year old, male, drowning, detection 1.5 months pm. [c] Place of finding: slope, 49 year old, female, polytrauma, detection 3 months pm) are characterized by incomplete mummification, skeletization and colliquation of soft-tissue. According to our experience medicolegal examiner's presence is necessary on the scene in order to secure in-situ-findings, to recover the human remains and to arrange a proper transport. The autopsy should be performed in the institute's autopsy-room because of access to better equipment e.g. light, air condition, x-ray, instruments. Under these conditions a high quality of forensic examination, improved training of students and police-officers and the dignity of the deceased can be maintained.

[Site of discovery in the bath tub. Evaluation of a fatality after four years using postmortem roentgen diagnosis]. / Zur Problematik des Auffindeortes Badewanne. Klärung eines Todesfalles nach vier Jahren unter Einsatz postmortaller Röntgendiagnostik.

On the one hand the following case demonstrates the problems of finding a dead body in the bathroom and on the other hand the importance of postmortem x-ray examinations. The corpse of an 65-year-old woman was discovered in her bath tub. At the body's feet there was a hair dryer. Investigations concerning murder were negative, circumstances appeared to be unsuspicious. That was why a postmortem examination was not performed. -4 years later murder had to be considered. After manual strangling the deceased and the hair dryer were layed into the bath tub. The corpse was exhumed and taken to a forensic autopsy. It was found that the hyoid bone and the superior horn of the thyroid cartilage were both fractured on the right. Damages caused by the preparation itself were excluded by using serial roentgenographs. These observations in combination with histological findings and the results of further investigations convincingly supported the suspicion of strangling by hand.

[Self-injury or attempted murder--analysis of an unusual case]. / Selbstbeschädigung oder versuchtes Tötungsdelikt--Analyse eines ungewöhnlichen Falles.

An unusual case of self-injury involving several, partly deep penetrating stab wounds is described. A young emotionally disturbed consulting-room assistant accused her husband of having inflicted the injuries upon her in the course of an argument over custody of the children. An analysis of the injury pattern showed clear indications of self-injury and willfully transferred blood from punctures in the woman's fingertips to the clothes of the accused. The case demonstrates that in cases involving members of a medical profession and individuals with psychiatric disorders, the possibility of highly unusual types of self-injury should not be excluded. It further emphasizes the importance of a physical examination performed by a medico-legal specialist.

[Extremely varied rectal temperatures in 10 fatalities after a house fire--a contribution to the significance of body weight in cadaver cooling]. / Extrem differierende Rektaltemperaturen bei zehn Todesfällen nach Wohnungsbrand--ein Beitrag zur Bedeutung des Körpergewichts bei der Leichenabkühlung.

Eight children at the age of one to eleven years, their mother and uncle were victims of fire that had broken out in their flat. They all died of combined carbon monoxide cyanide poisoning. The rectal temperature of the bodies taken nearly eight hours later ranged from 16 degrees C to 29 degrees C. Using the rectal temperature time of death nomogram (Henssge 1982) with reference to corrective factors of the body weight (Henssge and Madea 1988) to find out when they died, the results corresponded with the enquiries made by the police except for three cases. The rectal temperature of the apparently intact bodies of the three youngest children whose weight ranged from 9 to 14 kilograms was comparatively high. The reason for this may be that reduction in diameter and in weight of the body causes a heating up in a smaller amount of time. This is why one has to be careful to use the nomogram with fire victims especially with those of low weight.

[Postmortem roentgen diagnosis of the skull]. / Zur postmortalen Röntgendiagnostik des Schädels.

In this prospective study, skulls of 164 dead bodies were x-rayed in two different planes. The findings were assessed independent to the results of the subsequent autopsy, however afterwards compared with the autopsy findings. In 86 cases (53.4%) x-ray findings were significant. Dislocated calvarium fractures were clearly visible on the x-rays, however non-dislocated calvarium fractures as well as fractures of the visceral cranium and skull base were difficult to detect. Gas and foreign bodies could easily be observed. Similar to the clinical assessment the indication for a post-mortem x-ray of the skull must consider the case history and the respective condition of the corpse (for example putrefaction, charred body).