C. G. Birngruber

Superimposition technique for skull identification with Afloat® software

The craniofacial superimposition technique is still an important way of identifying skulls when there is no reference sample for a forensic DNA analysis, when DNA typing from remaining tissue samples has failed, or when antemortem dental records are not available. Through the widespread use of digital photography, the probability of portrait photographs of the missing person being available for comparison is reasonably high. We present a superimposition technique that is inexpensive, since it uses a free software tool compatible with the soft-and hardware components already being used in many facilities. Into the bargain, this technique yields high-quality results.

Inhaled cyanide poisoning as a vital sign in a room fire victim

The corpse of a 71-year-old woman was found on the floor of her smoke-filled room. The source of the fire was the mattress of a double bed on which newspapers had apparently been set aflame. The womans history in conjunction with the finding situation suggested an act of suicide. No signs of soot inhalation or soot swallowing were found at autopsy. Other vital signs were absent. Severe cardiac disease was the most notable pre-existing medical condition. Although the concentration of COHb in heart blood was low (3%), the concentration of cyanide was found to be 4.3mg/l in heart blood and 1.9mg/l in lung tissue. Cyanide was not found in the stomach contents. The BAC (blood alcohol concentration) was zero. Several prescribed drugs could also be demonstrated. The cause of death was deemed to be cyanide poisoning, possibly in conjunction with the pre-existing cardiac disease. The reported case illustrates that a lethal amount of cyanide can be inhaled during a fire even if there is no inhalation or swallowing of soot and no significant increase in the COHb level. In such cases, the demonstration of cyanide assumes significance as a vital sign indicating that the victim was alive when the fire started.

Histopathologische Diagnostik beim letalen Schütteltrauma

ZusammenfassungNach tödlich verlaufenen Fällen eines Schütteltraumas müssen Befunde, die die entsprechende Gewalteinwirkung belegen, im Rahmen der Obduktion und durch nachfolgende histologische Untersuchungen erhoben werden. Dies gilt v. a. für jene Schütteltraumaopfer, bei denen zu Lebzeiten keine klinische Diagnostik mehr erfolgen konnte. Aber auch ein antemortal bekannter Verdacht auf ein Schütteltrauma mit klassischen Befunden, wie z. B. einem subduralen Hämatom und retinalen Blutungen, gelegentlich auch mit paravertebralen Rippenfrakturen und subkutanen Einblutungen (Thorax, Oberarme), bedarf der autoptischen Beweissicherung. Wurde das Schütteltrauma zunächst überlebt, können Fragen der Altersbestimmung von Verletzungen relevant werden.AbstractIn fatal courses of shaken baby syndrome (SBS, non-accidental head injury, NAHI) findings that confirm the classical signs of this special form of violence must be collected during the autopsy and the subsequent histological investigations. This is particularly important for all victims of shaking trauma where clinical diagnostics could no longer be carried out during life. Even in cases where there was a known antemortem suspicion of shaken baby syndrome with typical autopsy findings, such as subdural hematoma and retinal hemorrhage, also occasionally with paravertebral rib fractures and subcutaneous bleeding (thorax, upper limbs), evidence needs to be collected during an autopsy. If the child initially survives the shaking trauma, questions on the age determination of injuries can be relevant.

Pregnancy-associated Death – Clarifying the Cause of Death and Medico-legal Assessments in Accusations of Malpractice

Background Pregnancy-associated deaths are extremely rare in Germany. Most deaths are from natural causes, and a range of causes are possible. Method The deaths of 22 women who died of pregnancy-associated causes and who were autopsied in the Institute of Forensic Medicine of Justus-Liebig University Gießen between 1992 and 2016 were analyzed. Results The autopsy results and histological examinations for the majority of women who died of pregnancy-associated causes between 1992 and 2016 showed that they had died of natural causes, although complications of pregnancy were a leading cause of death. Conclusion The death of a pregnant woman should not automatically raise the suspicion of malpractice, although the question does arise in cases of bleeding complications only detected at very late stages. Experts must prove that a real mistake was made during treatment and provide evidence of the causality between malpractice and patient death. Particularly when well-known complications of pregnancy were present, this is only the case if poor monitoring resulted in the complication being detected too late or if treatment was not in accordance with accepted standards of care. The majority of pregnancy-associated deaths are from natural causes and the death of a pregnant woman does not mean that medical malpractice was involved, although this accusation is often levelled in cases where rupture was not immediately diagnosed or in cases of fatal postpartum hemorrhage.

Fatal accidental inhalation of brake cleaner aerosols

Brake cleaner liquid is commonly used for cleaning of engines and motor parts. The commercially available products usually contain mainly volatile organic compounds. As a consequence brake cleaner evaporates fast and almost completely from the cleaned surface. This case report presents a fatal accidental inhalation of brake cleaner liquid aerosols due to the attempted cleaning of a boat engine. A 16year old boy was found lifeless in the engine compartment of a boat engine. In close proximity to the body, the police found cleanings wipes soaked with brake cleaner as well as a pump spray bottle filled with brake cleaner. Essentially the autopsy revealed a cerebral oedema with encephalomalacia, no coagulated blood as well as increased blood and tissue fluid content of the lung. Toxicological analysis revealed brake cleaner fluid in the lung, gastric content and heart blood.

Sudden Deaths in Police Custody (and Other Detention Facilities) – Analysis of Causes and the Need for Prevention

When a suspect or delinquent is taken into custody, the custodian (state authority) has to ensure, that custody is safe for the detainee and fulfills human rights standards. Nevertheless, (sudden) deaths in custody occur, that provoke questions and/or allegations towards the custodian. In these cases, independent (medico-legal) investigations are essential to clarify the circumstances of death and to identify risk-factors that can be considered in prevention campaigns.

Senior driving under the influence: A five-year retrospective study of alcoholized road-users aged 70 and over

The demographic development in Germany shows a steady increase to senior citizens. The driving suitability of older road-users is of large social and political concern, because awareness and reactivity can be influenced by age-related diseases and potential medication, particularly in combination with the consumption of alcohol. This study provides an overview of senior road-users under the influence of alcohol. Therefore, 404 cases of drunken-driving by road-users aged 70 and over within the purview of the Institute of Legal Medicine at Justus-Liebig-University, Giessen, from the years 2009-2013 were evaluated in retrospect. The vast majority of the drivers were male (88.4% of the cases). Distribution of the blood alcohol concentrations were almost equally in male and female drivers with 62.8% of all cases showing a blood alcohol concentration (BAC) of more than 1.1‰ and 10.9% a BAC of more than 2.0‰. In 48.5% of the cases, drunk driving was associated with an accident. 54.5% of the drivers stated suffering from at least one disease and 60% admitted a regular medication or an intake prior to the incident. Moreover, the collected data includes aspects such as the kind of traffic participation as well as neurological and physiological deficits of the road-users. If accidents were caused by drunk driving, the external circumstances and consequences of these accidents were analyzed, too. The evaluation revealed, that the standard medical examination protocol proved to be improbable to cover polypharmacy and multimorbidity of older alcoholized drivers. So, an evaluation and adaptation of the common medical examination protocol must be considered.