F. Driever

Fatal myeloencephalopathy due to accidental intrathecal vincristin administration : a report of two cases

We report on two fatal cases of accidental intrathecal vincristine instillation in a 5-year old girl with recurrent acute lymphoblastic leucemia and a 57-year old man with lymphoblastic lymphoma. The girl died seven days, the man four weeks after intrathecal injection of vincristine. Clinically, the onset was characterized by the signs of opistothonus, sensory and motor dysfunction and ascending paralysis. Histological and immunohistochemical investigations (HE-LFB, CD-68, Neurofilament) revealed degeneration of myelin and axons as well as pseudocystic transformation in areas exposed to vincristine, accompanied by secondary changes with numerous prominent macrophages. The clinical course and histopathological results of the two cases are presented. A review of all reported cases in the literature is given. A better controlled regimen for administering vincristine and intrathecal chemotherapy is recommended.

About morphological findings in fatal railway collisions

The autopsy findings in fatal cases of railway collisions of the Bonn Institute of Legal Medicine in 1992-1999 were investigated and compared to the statements in the investigation files of the public prosecutor with regard to classification as accident or suicide as well as with regard to type and speed of collision. Of the 38 deaths, 10 were hit in an upright position, 11 fatal collisions affected persons lying outside the track and 13 were hit and overrun lying inside the track. According to the investigation classification 21 persons committed suicide (56%), while 10 died in an accident (26%). Our survey confirmed the leading role of being over-rolled in a lying position as an indication for suicides, while in accidents the upright hit was most important. With exception of the persons primarily affected between the rails in upright position and over-rolled consecutively an unequivocal assignment of injury patterns to the hit categories was possible. In cases of persons being primarily over-rolled in a lying position especially the criteria (i) opening of body cavities, (ii) organ injuries and (iii) loss of parts of the body allowed for careful conclusion on hit, respectively, overrunning speed.

Todesursachenspektrum im Altenheim im Spiegel eines rechtsmedizinischen Sektionsgutes

Zusammenfassung34 Todesfälle im Altenheim aus dem Bonner Sektionsgut des 10-Jahres-Zeitraums 1991–2000 wurden retrospektiv im Hinblick auf ermittlungsseitige Fragestellungen, Todesursachenspektrum und Relevanz der rechtsmedizinischen Untersuchungsbefunde für den Verlauf des Ermittlungsverfahrens ausgewertet. Das Untersuchungsgut besteht aus 22 Frauen und 12 Männern im Alter von 62 bis 102 Jahren. Die Fragestellungen der Sektion umfassten allgemein formuliert Fremdverschulden, Pflegefehler, ärztliches Fehlverhalten, Vergiftungsverdacht und die Todesursächlichkeit von Sturzgeschehen. Als Todesart, bzw. Todesursachen fanden sich 21 natürliche Todesfälle (akute Koronarinsuffizienz, Pneumonie), 9 nichtnatürliche Todesfälle (Unterkühlung, Bolus, Verbrühung, Sturzfolge) und 4 unklare Todesfälle. In 30 von 34 Fällen war die Todesursache zweifelsfrei zu klären. In allen Fällen bildete das rechtsmedizinische Gutachten eine adäquate Entscheidungsgrundlage für die Ermittlungsbehörden, wobei insbesondere die Klärung eines Kausalzusammenhangs zwischen bei der Leichenschau festgestellten Verletzungen und dem Todeseintritt von Bedeutung war. Die Ermittlungsverfahren wurden ausnahmslos eingestellt.SummaryAutopsies from 34 fatalities in nursing homes covering a 10-year period (1991–2000) were retrospectively analyzed with regard to criminal investigative issues, causes of death and relevance of the forensic medical findings for the outcome of the criminal investigations. The material consisted of 22 females and 12 males, with the ages ranging from 62 to 102. The allegations to be investigated comprised wrongful death, improper nursing, medical maltreatment, suspicion of poisoning and the causal relationship between falls and the occurrence of death. The manner of death, respectively cause of death encountered included 21 deaths from natural cause (coronary insufficiency, pneumonia), 9 accidental deaths (hypothermia, choking, scalding burns and injuries due to fall) and 4 cases which remained undetermined. In 30 out of 34 cases, the cause of death was unequivocally established. In every case, the medicolegal investigation provided adequate evidence for the legal assessment. Of particular significance was the exclusion of a causal relationship between falls and the occurrence of death. Without exception, all investigations failed to uncover criminal causes for death in this sample.

[Causes of death in nursing homes--a retrospective autopsy study].

Zusammenfassung34 Todesfälle im Altenheim aus dem Bonner Sektionsgut des 10-Jahres-Zeitraums 1991–2000 wurden retrospektiv im Hinblick auf ermittlungsseitige Fragestellungen, Todesursachenspektrum und Relevanz der rechtsmedizinischen Untersuchungsbefunde für den Verlauf des Ermittlungsverfahrens ausgewertet. Das Untersuchungsgut besteht aus 22 Frauen und 12 Männern im Alter von 62 bis 102 Jahren. Die Fragestellungen der Sektion umfassten allgemein formuliert Fremdverschulden, Pflegefehler, ärztliches Fehlverhalten, Vergiftungsverdacht und die Todesursächlichkeit von Sturzgeschehen. Als Todesart, bzw. Todesursachen fanden sich 21 natürliche Todesfälle (akute Koronarinsuffizienz, Pneumonie), 9 nichtnatürliche Todesfälle (Unterkühlung, Bolus, Verbrühung, Sturzfolge) und 4 unklare Todesfälle. In 30 von 34 Fällen war die Todesursache zweifelsfrei zu klären. In allen Fällen bildete das rechtsmedizinische Gutachten eine adäquate Entscheidungsgrundlage für die Ermittlungsbehörden, wobei insbesondere die Klärung eines Kausalzusammenhangs zwischen bei der Leichenschau festgestellten Verletzungen und dem Todeseintritt von Bedeutung war. Die Ermittlungsverfahren wurden ausnahmslos eingestellt.SummaryAutopsies from 34 fatalities in nursing homes covering a 10-year period (1991–2000) were retrospectively analyzed with regard to criminal investigative issues, causes of death and relevance of the forensic medical findings for the outcome of the criminal investigations. The material consisted of 22 females and 12 males, with the ages ranging from 62 to 102. The allegations to be investigated comprised wrongful death, improper nursing, medical maltreatment, suspicion of poisoning and the causal relationship between falls and the occurrence of death. The manner of death, respectively cause of death encountered included 21 deaths from natural cause (coronary insufficiency, pneumonia), 9 accidental deaths (hypothermia, choking, scalding burns and injuries due to fall) and 4 cases which remained undetermined. In 30 out of 34 cases, the cause of death was unequivocally established. In every case, the medicolegal investigation provided adequate evidence for the legal assessment. Of particular significance was the exclusion of a causal relationship between falls and the occurrence of death. Without exception, all investigations failed to uncover criminal causes for death in this sample.