Postmortem 1H-MRS-Detection of Ketone Bodies and Glucose in Diabetic Ketoacidosis.

Diabetic ketoacidosis (DKA) is a metabolic complication of diabetes mellitus that takes a lethal course if untreated. In this way relevant to forensic medicine, secure diagnosis of DKA usually involves the evidence of elevated levels of glucose and the ketone bodies acetone, acetoacetate, and ß-hydroxybutyrate in corpse fluids. We conducted a postmortem hydrogen proton magnetic resonance spectroscopy (1H-MRS) in a case of lethal DKA. Distinctive resonances of all three ketone bodies as well as glucose were visible in spectra of cerebrospinal fluid, vitreous humor, and white matter. Estimated concentrations of ketone bodies and glucose supported the findings both of autopsy and biochemical analysis. Advantages of human postmortem 1H-MRS are the lack of movement and flow artifacts as well as lesser limitations of scan duration. Postmortem 1H-MRS is able to non-invasively measure concentrations of glucose and ketone bodies in small volumes of various regions of the brain. It may thus become a diagnostic tool for forensic investigations by quick determination of pathological metabolite concentrations in addition to conventional autopsy.

Padova Charter on personal injury and damage under civil-tort law : Medico-legal guidelines on methods of ascertainment and criteria of evaluation.

Compensation for personal damage, defined as any pecuniary or non-pecuniary loss causally related to a personal injury under civil-tort law, is strictly based on the local jurisdiction and therefore varies significantly across the world. This manuscript presents the first "International Guidelines on Medico-Legal Methods of Ascertainment and Criteria of Evaluation of Personal Injury and Damage under Civil-Tort Law". This consensus document, which includes a step-by-step illustrated explanation of flow charts articulated in eight sequential steps and a comprehensive description of the ascertainment methodology and the criteria of evaluation, has been developed by an International Working Group composed of juridical and medico-legal experts and adopted as Guidelines by the International Academy of Legal Medicine (IALM).

Fatal visit to the general practitioner.

A 31-year-old female asthmatic patient received an infusion of metamizole and tramadol for chronic pain at a GP surgery. After a few minutes, the patient developed breaing difficulties and died in spite of resuscitation measures. The general practitioner was suspected of medical malpractice. Medico-legal investigations confirmed the assumption that death was caused by anaphylacitic shock. In spite of temporary intubation into the oesophagus no evidence of medical malpractice was found, however.

Fatal visit to the dentist.

A 23-year-old woman was mortally afraid of dental interventions and decided to have her four wisdom teeth removed by outpatient surgery under endotracheal anaesthesia. According to the files, the patient was categorized as ASA I and Mallampati II, and surgery was considered an elective routine intervention. Soon after initiation of anaesthesia, O2 saturation and blood pressure dropped, and the young woman died shortly afterwards in spite of immediate resuscitation measures. At first, an allergic reaction to succinylcholine, which had been administered as a muscle relaxant, was suspected. Autopsy and histological examination showed haemorrhagic pulmonary oedema and a defined lesion in the midportion of the oesophageal mucosa in spite of correct placement of the endotracheal breathing tube. Ultimately, misintubation into the oesophagus, which had not been noticed at first, was determined as cause of death.

Spectrometric evaluation of post-mortem optical skin changes.

As to their optical properties, the components of human skin can be divided into two different categories: the light-scattering components shown as peaks and those absorbing light appearing as dips in the reflectance spectrum. As the post-mortem interval progresses, the concentration of scatterers and absorbers and thus the reflectance spectra change due to post-mortem tissue breakdown and degradation. Based on a total number of 532 reflectance spectrometric measurements in 195 deceased, a characteristic change in the reflectance spectra could be documented in the post-mortem course. Subsequently, an algorithm to calculate the post-mortem interval was developed by analysing the reflectance spectrometric extrema.

Accident or crime? About the meaning of face injuries inflicted by blunt force.

Injuries caused by blunt force are seen frequently in daily forensic casework. Sometimes, especially when there is less information about the surrounding circumstances, it might become difficult to figure out the cause and background of injuries: accident, criminal violence or self-infliction? In the study presented, face injuries caused by blunt force in 694 cases were analyzed comparing the injury patterns in accidents to those in crimes. It turned out injuries of the ear and retroauricular region clearly indicate a crime. Also, soft tissue injuries of nose, upper jaw, and lower jaw point towards a criminal violence, whereas tooth injuries occur with a similar frequency in both crimes and accidents.

Similarity analysis of spectra obtained via reflectance spectrometry in legal medicine.

In the present study, a series of reflectance spectra of postmortem lividity, pallor, and putrefaction-affected skin for 195 investigated cases in the course of cooling down the corpse has been collected. The reflectance spectrometric measurements were stored together with their respective metadata in a MySQL database. The latter has been managed via a scientific information repository. We propose similarity measures and a criterion of similarity that capture similar spectra recorded at corpse skin. We systematically clustered reflectance spectra from the database as well as their metadata, such as case number, age, sex, skin temperature, duration of cooling, and postmortem time, with respect to the given criterion of similarity. Altogether, more than 500 reflectance spectra have been pairwisely compared. The measures that have been used to compare a pair of reflectance curve samples include the Euclidean distance between curves and the Euclidean distance between derivatives of the functions represented by the reflectance curves at the same wavelengths in the spectral range of visible light between 380 and 750 nm. For each case, using the recorded reflectance curves and the similarity criterion, the postmortem time interval during which a characteristic change in the shape of reflectance spectrum takes place is estimated. The latter is carried out via a software package composed of Java, Python, and MatLab scripts that query the MySQL database. We show that in legal medicine, matching and clustering of reflectance curves obtained by means of reflectance spectrometry with respect to a given criterion of similarity can be used to estimate the postmortem interval.

Analyzing reflectance spectra of human skin in legal medicine.

Our current research in the framework of an interdisciplinary project focuses on modelling the dynamics of the hemoglobin reoxygenation process in post-mortem human skin by reflectance spectrometry. The observations of reoxygenation of hemoglobin in livores after postmortem exposure to a cold environment relate the reoxygenation to the commonly known phenomenon that the color impression of livores changes from livid to pink under low ambient temperatures. We analyze the spectra with respect to a physical model describing the optical properties of human skin, discuss the dynamics of the reoxygenation, and propose a phenomenological model for reoxygenation. For additional characterization of the reflectance spectra, the curvature of the local minimum and maximum in the investigated spectral range is considered. There is a strong correlation between the curvature of specra at a wavelength of 560 nm and the concentration of O2-Hb. The analysis is carried out via C programs, as well as MySQL database queries in Java EE, JDBC, Matlab, and Python.

Suicide of a man with known allergy to fish protein by ingesting tinned fish.

On a day in November, the body of a 31-year-old man was found near a swimming lake with two open and partly emptied fish tins lying next to him. Further investigations showed that the man had been allergic to fish protein and suffered from severe depression and drug psychosis. Already some days before the suicide, he had repeatedly asked for fish to kill himself. Although the results of the chemical and toxicological examinations were negative, the autopsy findings and histological tests suggest that death was caused by an anaphylactic reaction.

Scientific information repository assisting reflectance spectrometry in legal medicine.

Reflectance spectrometry is a fast and reliable method for the characterization of human skin if the spectra are analyzed with respect to a physical model describing the optical properties of human skin. For a field study performed at the Institute of Legal Medicine and the Freiburg Materials Research Center of the University of Freiburg, a scientific information repository has been developed, which is a variant of an electronic laboratory notebook and assists in the acquisition, management, and high-throughput analysis of reflectance spectra in heterogeneous research environments. At the core of the repository is a database management system hosting the master data. It is filled with primary data via a graphical user interface (GUI) programmed in Java, which also enables the user to browse the database and access the results of data analysis. The latter is carried out via Matlab, Python, and C programs, which retrieve the primary data from the scientific information repository, perform the analysis, and store the results in the database for further usage.

Stab or throw? Biomechanical studies on the injuring potential of glass fragments.

During a Christmas party, two male guests started fighting. The perpetrator was allegedly pushed onto a glass table by the victim or fell into the table together with that man so that the glass top broke and caused a cut wound on the perpetrator's back. According to his statement he then threw a fragment of the broken glass table in the direction of the other man hitting him accidentally in a way so that the subclavian artery was severed and he died from exsanguination. Tests on the breaking characteristics of the glass table, the flying behaviour and the kinetics of thrown glass fragments conducted on various models supported the conclusion that the fatal injury on the victim's neck could not have been caused by a thrown glass fragment. It was much more likely that a stab with a blade-shaped glass fragment was the cause of the fatal injuries.

Injuring potential of drinking glasses.

At a party of a sports club, an argument started between two groups of young men, in the course of which one of the persons involved threw a beer glass hitting a young man of the other group, who collapsed with a profusely bleeding wound. Although resuscitation measures were initiated immediately, the victim died at the scene due to exsanguination from the completely severed left external carotid artery in combination with the aspiration of blood. Tests with drinking glasses thrown at a skull-neck model suggested that an undamaged beer glass thrown at the head of the victim could not cause the fatal injuries on the neck because of its splintering behaviour. In fact, it seemed that the beer glass had been damaged prior to throwing it and that its sharp edges perforated the skin on hitting the neck.