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Die Beurteilung von Verletzungen durch Schusswaffen gehört zu den typischen Aufgaben der Rechtsmedizin. In den vorangegangenen Kapiteln wurde deutlich dargelegt, dass auf Grund einer Vielzahl zu berücksichtigender physikalischer Parameter und Effekte die rechtsmedizinische Beurteilung derartiger Verletzungen recht komplex ist. Insbesondere spielt die Kurzzeitigkeit der Vorgänge (eine Schussverletzung findet innerhalb einiger weniger Millisekunden statt) eine ganz entscheidende Rolle.

In the situation of a shortage of ventilation beds, ethically justifiable, transparent and comprehensible decisions must be made. This concept proposes that all patients are first intubated depending on necessity and then assessed by a triage team afterwards. In this situation newly admitted COVID patients compete with newly admitted Non-COVID patients as well as patients already treated in intensive care units for a ventilator. The combination of short-term and long-term prognoses should enable the interprofessional triage team to make comprehensible decisions. The aim of the prioritization concept is to save as many human lives as possible and to relieve the treatment team of the difficult decision on prioritization.

A man was found injured with a cut on the left side of his neck and unconscious on the floor of his garage. He reported being attacked from behind, robbed and injured with a sharp instrument. During the analysis of the blood trace pattern doubts arose if the story of the man was true and a self-inflicted injury could be considered. If the course of events is reconstructed on the basis of blood traces, the incident did not take place at one place. In a niche a carpet knife was found hidden in an oil canister. After extensive investigations a suspect was exonerated and the injured person was sentenced for feigning the commission of a crime.

A man was found injured with a cut on the left side of his neck and unconscious on the floor of his garage. He reported being attacked from behind, robbed and injured with a sharp instrument. During the analysis of the blood trace pattern doubts arose if the story of the man was true and a self-inflicted injury could be considered. If the course of events is reconstructed on the basis of blood traces, the incident did not take place at one place. In a niche a carpet knife was found hidden in an oil canister. After extensive investigations a suspect was exonerated and the injured person was sentenced for feigning the commission of a crime.

In the situation of a shortage of ventilation beds, ethically justifiable, transparent and comprehensible decisions must be made. This concept proposes that all patients are first intubated depending on necessity and then assessed by a triage team afterwards. In this situation newly admitted COVID patients compete with newly admitted Non-COVID patients as well as patients already treated in intensive care units for a ventilator. The combination of short-term and long-term prognoses should enable the interprofessional triage team to make comprehensible decisions. The aim of the prioritization concept is to save as many human lives as possible and to relieve the treatment team of the difficult decision on prioritization.

Introduction: The curricular implementation of events (or programs) for science-related training in human medicine has been on the agenda of the medical faculties since the publication of the Federal-State Working Group . The Medical Faculty of the University of Cologne developed and established a systematic, longitudinal science curriculum together with the start of the model curriculum in human medicine in 2003. Here, we investigate the questions of whether the described (para-) curricular elements are accepted by students and lecturers and how they are evaluated, especially by students. In addition, we investigate whether selected parameters can be used to demonstrate changes in the students' scientific activities.Project description: The program "Research and Medical Studies" (RaMS) consists of several components: these elements of the mandatory curricular (Scientific Projects, SP) and optional components (Research in Medical Studies (RiMS), Research Track (RT), Research Fair Cologne (RFC)) are described here. Results were recorded at various levels: Likert Scale evaluation of the event's elements were collected as satisfaction parameters from the students Process data on participation in the voluntary events were collected and evaluated as absolute and relational figures (WS 12/13-SS 17). Data on the outcome of the RaMS program were collected: Type of scientific projects in the academic years 2011/12-2014/15), number and type of available projects offered at the RFC (in the years 2011-18) and number of student research funding applications in a comparison of the periods 2010-13 vs. 2014-17). Results: The students' acceptance of mandatory and paracurricular courses of the RaMS program is pleasingly high, which is not surprising, at least in the case of the voluntary courses. The participation of students in RiMS, RT and RFC is satisfactory for voluntary courses. In the case of the RT, with certified participation of approximately 47% of all registrations (corres, Einleitung: Die curriculare Implementierung von Veranstaltungen (bzw. Programmen) zur wissenschaftsbezogenen Ausbildung in der Humanmedizin steht spätestens seit der Publikation der Bund-Länder-Arbeitsgruppe auf der Agenda der Medizinischen Fakultäten. Die Medizinische Fakultät der Universität zu Köln hat mit Beginn des Modellstudiengangs Humanmedizin 2003 ein systematisches, longitudinales Wissenschaftscurriculum entwickelt und etabliert. Hier untersuchen wir die Fragen, ob die beschrieben (para-) curricularen Elemente von den Studierenden und Lehrenden angenommen und wie diese insbesondere von den Studierenden bewertet werden. Zudem wird untersucht, ob sich anhand ausgewählter Parameter eine Änderung der wissenschaftlichen Aktivitäten der Studierenden beschreiben lässt.Projektbeschreibung: Das Programm "Forschung und Medizinstudium" (FuM) besteht aus mehreren Komponenten: Diese Elemente der pflichtcurricularen (Wissenschaftliche Projekte, WP) und additiven Anteile (Forschung im Medizinstudium (FiM), Research Track (RT), Forschungsbörse Medizin Köln (FBK)) werden beschrieben. Ergebnissicherungen wurden auf verschiedenen Ebenen durchgeführt: Likert-skalierte studentische Veranstaltungskritiken zu den Elementen wurden als Zufriedenheitsparameter erhoben. Prozessdaten zur Teilnahme an den freiwilligen Veranstaltungen wurden erhoben und als absolute sowie als relationale Zahlen ausgewertet (WS 12/13-SS 17). Daten zum Outcome des Programms FuM wurden erhoben: Art der Wissenschaftlichen Projekte den Studienjahren 2011/12-2014 /15), Anzahl und Art der vermittelten Projekte auf der FBK (in den Jahren 2011-18) und Anzahl studentischer Forschungsförderungsanträge im Vergleich der Zeiträume 2010-13 vs. 2014-17). Ergebnisse: Die Akzeptanz der Studierenden von pflicht- sowie paracurricularen Veranstaltungen des Programms FuM ist erfreulich hoch, was zumindest bei den freiwilligen Veranstaltungen nicht verwundert. Die Teilnahme der Studierenden an FiM, RT und FBK ist für freiwil

Fractures of the sternum are rare compared to other bone fractures. Especially in children, sternal fractures are rarely diagnosed and represent only a small percentage of the total number of sternal fractures. In the case of a 10-year-old boy, he presented to the pediatrician with constant breathing-related pain in the chest region and similar complaints had already existed 1 week ago. The sonographic examination revealed a suspected fracture of the sternum, which was confirmed by a subsequent X-ray examination. After discussing the findings the mother stated that the pain first occurred after the 12-year-old cousin had hit the sternum of her son with his knee. The question of the plausibility of the claimed injury mechanism was raised. Against the background of the described case, an overview of epidemiological data, underlying injury mechanisms and anatomical peculiarities of isolated sternal fractures in childhood is given, with reference to the current literature. It could be shown that isolated sternal fractures can occur during age-typical playing activities. In the overall view, the plausibility of the stated injury mechanism could therefore be confirmed in the presented case.

Physical match examinations usually pursue the goal of proving the former unity of fragments. Each fracture structure is individually formed and thus distinguishable. An irregular sequence of changes in direction of the fracture creates the fracture structure, which is influenced by a multitude of non-reproducible factors. The examination of fracture surfaces is carried out with forensic comparative light microscopes and using reverse lighting. Alternatively, 3D surface scanners and comparison software are increasingly used in forensic science. This article presents three cases in which fragments that remained in the body of the victim after attacks by sharp and blunt forces were compared with the weapons of the perpetrators. In addition, recommendations are given for the photographic documentation and recovery of fragments in a way that does not damage the fracture surfaces. In two of the presented case studies, the victim was attacked with knives and fragments of the knife blades remained in the body of the victim. In the third case, the perpetrators used a wooden baseball bat of which a fragment remained in a head wound of the victim. In all three cases the fragments could be assigned to the weapons based on the fracture structures.

Fractures of the sternum are rare compared to other bone fractures. Especially in children, sternal fractures are rarely diagnosed and represent only a small percentage of the total number of sternal fractures. In the case of a 10-year-old boy, he presented to the pediatrician with constant breathing-related pain in the chest region and similar complaints had already existed 1 week ago. The sonographic examination revealed a suspected fracture of the sternum, which was confirmed by a subsequent X-ray examination. After discussing the findings the mother stated that the pain first occurred after the 12-year-old cousin had hit the sternum of her son with his knee. The question of the plausibility of the claimed injury mechanism was raised. Against the background of the described case, an overview of epidemiological data, underlying injury mechanisms and anatomical peculiarities of isolated sternal fractures in childhood is given, with reference to the current literature. It could be shown that isolated sternal fractures can occur during age-typical playing activities. In the overall view, the plausibility of the stated injury mechanism could therefore be confirmed in the presented case.

Physical match examinations usually pursue the goal of proving the former unity of fragments. Each fracture structure is individually formed and thus distinguishable. An irregular sequence of changes in direction of the fracture creates the fracture structure, which is influenced by a multitude of non-reproducible factors. The examination of fracture surfaces is carried out with forensic comparative light microscopes and using reverse lighting. Alternatively, 3D surface scanners and comparison software are increasingly used in forensic science. This article presents three cases in which fragments that remained in the body of the victim after attacks by sharp and blunt forces were compared with the weapons of the perpetrators. In addition, recommendations are given for the photographic documentation and recovery of fragments in a way that does not damage the fracture surfaces. In two of the presented case studies, the victim was attacked with knives and fragments of the knife blades remained in the body of the victim. In the third case, the perpetrators used a wooden baseball bat of which a fragment remained in a head wound of the victim. In all three cases the fragments could be assigned to the weapons based on the fracture structures.

Vitamin A is essential for human health, but current intake levels in many developing countries such as India are too low due to malnutrition. According to the World Health Organization, an estimated 250 million preschool children are vitamin A deficient globally. This number excludes pregnant women and nursing mothers, who are particularly vulnerable. Efforts to improve access to vitamin A are key because supplementation can reduce mortality rates in young children in developing countries by around 23%. Three key genes, BCMO1, BCO2, and SCARB1, have been shown to be associated with the amount of β-carotene (BC) in milk. Whole-genome sequencing reads from the coordinates of these 3 genes in 202 non-Indian cattle (141 Bos taurus, 61 Bos indicus) and 35 non-Indian buffalo (Bubalus bubalis) animals from several breeds were collected from data repositories. The number of SNP detected in the coding regions of these 3 genes ranged from 16 to 26 in the 3 species, with 5 overlapping SNP between B. taurus and B. indicus. All these SNP together with 2 SNP in the upstream part of the gene but already present in dbSNP (https://www.ncbi.nlm.nih.gov/projects/SNP/) were used to build a custom Sequenom array. Blood for DNA and milk samples for BC were obtained from 2,291 Indian cows of 5 different breeds (Gir, Holstein cross, Jersey Cross, Tharparkar, and Sahiwal) and 2,242 Indian buffaloes (Jafarabadi, Murrah, Pandharpuri, and Surti breeds). The DNA was extracted and genotyped with the Sequenom array. For each individual breed and the combined breeds, SNP with an association that had a P-value

A55-year-old man was found lifeless next to his car on an autobahn. On the left side of the neck there were huge gaping laceration type wounds. During the autopsy the injuries were found to partially have fine abrasions at the border and irregular margins of the wounds. The cause of death was named as injury-related polytrauma with inhalation of blood. During the further investigations atruck was seized, which showed sharp-edged damage to the metal on the right front of the vehicle. The injuries on the corpse were consistent with the ragged damaged edges on the truck so that this could be interpreted as aform of unusual and accident-related contact of the man with the truck.

Diabetes mellitus is one of the most common chronic diseases in childhood and adolescence, whereby a clear increase in the prevalence of type 2 diabetes mellitus can be observed in this age group. This disease can lead not only to long-term damage but also to sometimes fatal complications, especially in puberty. This article presents two autopsy cases with such fatal complications. In one case the underlying disease was type 1 diabetes mellitus and in the second case type 2 diabetes mellitus. Following the autopsy in both cases post-mortem biochemical and toxicological investigations could be carried out and by the use of the Traub formula the cause of death could be established as a diabetic coma (hyperosmolar and ketoacidotic) due to insufficient administration of insulin.

Background Sexual violence is a present problem in our society; however, many assaults are not reported by those affected. In order to make it possible for forensic evidence to be obtained from the persons concerned despite the fact that the incidents were only reported at a later date, different organizational structures have been set up in North Rhine-Westphalia and other federal states. Objective The cases registered at the Institute of Forensic Medicine were examined from a statistical point of view and related to the general experience gained over this period. Material and methods Retrospectively, all cases with anonymous evidence collection (ASS) at the Institute of Forensic Medicine of the Medical Faculty of the University of Cologne were analyzed for the period from 5 June 2011 to 31 December 2018. The case collective was scientifically analyzed. Results The registered cases (total so far 275) showed an accumulation in the urban area of Cologne compared to the surrounding towns and showed a peak in the age groups of 14-20 years old as well as 21-30 years old. So far, only samples from female persons have been received. On average 5.9 evidential items were registered per case, including swabs, clothing, blood and urine samples. In 28 cases, a complaint was subsequently filed. Formalities (e.g. labelling and sealing) were the main problems in the course of evidence collection. In principle, good acceptance and improvement in the documentation of cases of anonymous forensic evidence after sexual offences was shown over the entire period.

A 75-year-old woman refused medical treatment of a squamous cell carcinoma of the facial skin for personal reasons, which led to a pronounced finding with exposure of brain structures. Cutaneous squamous cell carcinomas (PEK) account for almost 20% of all non-melanocytic skin tumors and are the second most frequent skin tumor after basal cell carcinoma. The incidence increases with age. Etiologically, actinic precancerous skin lesions caused by ultraviolet (UV) radiation as well as long-term damage caused by chemical noxae and also chronic inflammatory and degenerative skin changes play a role. The cause of death in the present case was a tumor toxic cardiovascular failure with pronounced tumor cachexia. It was impressive that even with destruction of the skull and brain parenchyma, death occurred in such an advanced stage of the disease and not earlier in time. The relatives could not be reproached for failing to provide help as an adult person in a state of clear thinking is allowed to refuse treatment.

A55-year-old man was found lifeless next to his car on an autobahn. On the left side of the neck there were huge gaping laceration type wounds. During the autopsy the injuries were found to partially have fine abrasions at the border and irregular margins of the wounds. The cause of death was named as injury-related polytrauma with inhalation of blood. During the further investigations atruck was seized, which showed sharp-edged damage to the metal on the right front of the vehicle. The injuries on the corpse were consistent with the ragged damaged edges on the truck so that this could be interpreted as aform of unusual and accident-related contact of the man with the truck.

Diabetes mellitus is one of the most common chronic diseases in childhood and adolescence, whereby a clear increase in the prevalence of type 2 diabetes mellitus can be observed in this age group. This disease can lead not only to long-term damage but also to sometimes fatal complications, especially in puberty. This article presents two autopsy cases with such fatal complications. In one case the underlying disease was type 1 diabetes mellitus and in the second case type 2 diabetes mellitus. Following the autopsy in both cases post-mortem biochemical and toxicological investigations could be carried out and by the use of the Traub formula the cause of death could be established as a diabetic coma (hyperosmolar and ketoacidotic) due to insufficient administration of insulin.

Background Sexual violence is a present problem in our society; however, many assaults are not reported by those affected. In order to make it possible for forensic evidence to be obtained from the persons concerned despite the fact that the incidents were only reported at a later date, different organizational structures have been set up in North Rhine-Westphalia and other federal states. Objective The cases registered at the Institute of Forensic Medicine were examined from a statistical point of view and related to the general experience gained over this period. Material and methods Retrospectively, all cases with anonymous evidence collection (ASS) at the Institute of Forensic Medicine of the Medical Faculty of the University of Cologne were analyzed for the period from 5 June 2011 to 31 December 2018. The case collective was scientifically analyzed. Results The registered cases (total so far 275) showed an accumulation in the urban area of Cologne compared to the surrounding towns and showed a peak in the age groups of 14-20 years old as well as 21-30 years old. So far, only samples from female persons have been received. On average 5.9 evidential items were registered per case, including swabs, clothing, blood and urine samples. In 28 cases, a complaint was subsequently filed. Formalities (e.g. labelling and sealing) were the main problems in the course of evidence collection. In principle, good acceptance and improvement in the documentation of cases of anonymous forensic evidence after sexual offences was shown over the entire period.

A 75-year-old woman refused medical treatment of a squamous cell carcinoma of the facial skin for personal reasons, which led to a pronounced finding with exposure of brain structures. Cutaneous squamous cell carcinomas (PEK) account for almost 20% of all non-melanocytic skin tumors and are the second most frequent skin tumor after basal cell carcinoma. The incidence increases with age. Etiologically, actinic precancerous skin lesions caused by ultraviolet (UV) radiation as well as long-term damage caused by chemical noxae and also chronic inflammatory and degenerative skin changes play a role. The cause of death in the present case was a tumor toxic cardiovascular failure with pronounced tumor cachexia. It was impressive that even with destruction of the skull and brain parenchyma, death occurred in such an advanced stage of the disease and not earlier in time. The relatives could not be reproached for failing to provide help as an adult person in a state of clear thinking is allowed to refuse treatment.

Background. Although corpse disposal itself is not a rare phenomenon, the wrapping of a corpse is less common, and its facets can be very varied. Objective. The cases available enabled different constellations to be determined and analyzed with respect to the method, motivation and type of wrapping. Material and methods. A retrospective analysis of forensic post-mortem examinations from 2009-2016 at the Institute of Forensic Medicine at the Cologne Medical School was conducted. Cases and results of the postmortem examinations were scientifically reviewed. The evaluation included only cases of corpses that had been fully or partly wrapped. Results. These cases represent a broad range of constellations including seven cases of completed homicide, three cases of completed suicide, one case of an autoerotic fatality and one case of natural death. In cases of homicide the corpse is generally wrapped for transportation and concealment but the placement and wrapping of the corpse vary. Just as varied and imaginative are the wrappings of corpses resulting from suicide, autoerotic accidents and more harmless cases.

An almost 3aEuroyear-old girl was brought to the pediatric surgery department by her mother at night. The patient presented with the chief complaint of a massive, deformed helmet-shaped, fluctuating and pressure-sensitive swelling of the head. The history of the present injury allegedly began with nocturnal awakening to find the aforementioned physical findings and no visible scalp injury. The neurological examination was clinically uneventful. Anemia was present but did not require a blood transfusion. A coagulation disorder could be excluded by laboratory analysis. Other previous medical and surgical interventions were non-contributory. Cross-sectional magnetic resonance imaging (MRI) and ultrasound imaging of the skull revealed a marked subgaleal hematoma, without intracranial pathologies. Paravertebral hematomas and crescent-shaped superficial lesions were noted on the girl's back, which could be explained by violently embracing the thorax. A non-accidental trauma as a result of a tangential, shearing force against the head was suspected. Subsequently, a broad subgaleal hematoma extending over the sutures was noted and was macromorphologically easily distinguishable from a locally limited cephalohematoma. Violent tearing of the scalp hair was suspected to be the most likely cause.

This report discusses the case of presumed unusual abuse of an 11-year-old boy with a central African background. The boy presented with deep cuts on the back of both hands which contained traces of chili powder. This unusual injury, which was ostensibly meted out by his mother, was discovered by family friends and finally reported by the children's hospital emergency unit doctors to the child protection services. During the legal proceedings, the mother denied any responsibility for the crime even though she had initially admitted her actions. The court convicted her of the abuse of a ward in concomitance with aggravated battery. She was sentenced to a term of 1 year and 1 month on probation.

In the case of the death of a76-year-old woman, the situation found at the scene including adistinctive bloodstain pattern and multiple sharp force trauma pointed to the question, whether the injuries were self-inflicted. Due to the results of the bloodstain pattern analysis, autopsy and toxicological analyses in combination with the police investigations, death by a third party could be excluded. Death was due to hemorrhagic shock caused by external bleeding through massive self-inflicted injuries. A special feature of the findings was the intensity of the cuts to the wrist leading to subtotal amputation of the hand.

The bodies of a27-year-old woman and a44-year-old man were found lying entwined on their bed. Alarge-caliber revolver lay on the bed next to them. The forensic examinations at the discovery site and the subsequent medico-legal autopsies revealed afatal, sagittal gunshot wound of the thorax with atrajectory from back to front in the woman. The underlying man showed aretained projectile with asagittal bullet track from the entrance wound in the middle of the anterior chest wall to the spinal column. Examinations at the scene carried out to estimate the time since death showed consistent results for both persons with acoincident time of death approximately 7h before the time of examination. The results of the subsequently conducted toxicological investigations revealed an acute influence by exceptionally high concentrations of amphetamine in the woman and acombined intoxication with amphetamine, ecstasy and alcohol in the man. Both individuals showed metabolites indicative of previous cocaine consumption. In conjunction with the police investigations, the forensic medical findings strongly suggested an unusual case of double suicide.

Shaken baby syndrome (SBS) is awell-known phenomenon in the field of forensic and pediatric experts; however, there are difficulties and controversies when it comes to biomechanical reconstruction as neither experimental studies nor independent witnesses exist. Apossible source of information comes from perpetrators' confessions if available. We present two cases of confirmed SBS, where one includes abroad confession and the other contains an interview with the perpetrator who confessed to the crime. Both perpetrators reported similar social environmental situations (overwhelmed by crying children) and similar descriptions of how the child was handled (hands on both sides of the thorax, shaken back and forth). Both children ceased crying after being shaken and died despite medical treatment for the injuries.

Background. Although corpse disposal itself is not a rare phenomenon, the wrapping of a corpse is less common, and its facets can be very varied. Objective. The cases available enabled different constellations to be determined and analyzed with respect to the method, motivation and type of wrapping. Material and methods. A retrospective analysis of forensic post-mortem examinations from 2009-2016 at the Institute of Forensic Medicine at the Cologne Medical School was conducted. Cases and results of the postmortem examinations were scientifically reviewed. The evaluation included only cases of corpses that had been fully or partly wrapped. Results. These cases represent a broad range of constellations including seven cases of completed homicide, three cases of completed suicide, one case of an autoerotic fatality and one case of natural death. In cases of homicide the corpse is generally wrapped for transportation and concealment but the placement and wrapping of the corpse vary. Just as varied and imaginative are the wrappings of corpses resulting from suicide, autoerotic accidents and more harmless cases.

An almost 3aEuroyear-old girl was brought to the pediatric surgery department by her mother at night. The patient presented with the chief complaint of a massive, deformed helmet-shaped, fluctuating and pressure-sensitive swelling of the head. The history of the present injury allegedly began with nocturnal awakening to find the aforementioned physical findings and no visible scalp injury. The neurological examination was clinically uneventful. Anemia was present but did not require a blood transfusion. A coagulation disorder could be excluded by laboratory analysis. Other previous medical and surgical interventions were non-contributory. Cross-sectional magnetic resonance imaging (MRI) and ultrasound imaging of the skull revealed a marked subgaleal hematoma, without intracranial pathologies. Paravertebral hematomas and crescent-shaped superficial lesions were noted on the girl's back, which could be explained by violently embracing the thorax. A non-accidental trauma as a result of a tangential, shearing force against the head was suspected. Subsequently, a broad subgaleal hematoma extending over the sutures was noted and was macromorphologically easily distinguishable from a locally limited cephalohematoma. Violent tearing of the scalp hair was suspected to be the most likely cause.

This report discusses the case of presumed unusual abuse of an 11-year-old boy with a central African background. The boy presented with deep cuts on the back of both hands which contained traces of chili powder. This unusual injury, which was ostensibly meted out by his mother, was discovered by family friends and finally reported by the children's hospital emergency unit doctors to the child protection services. During the legal proceedings, the mother denied any responsibility for the crime even though she had initially admitted her actions. The court convicted her of the abuse of a ward in concomitance with aggravated battery. She was sentenced to a term of 1 year and 1 month on probation.

In the case of the death of a76-year-old woman, the situation found at the scene including adistinctive bloodstain pattern and multiple sharp force trauma pointed to the question, whether the injuries were self-inflicted. Due to the results of the bloodstain pattern analysis, autopsy and toxicological analyses in combination with the police investigations, death by a third party could be excluded. Death was due to hemorrhagic shock caused by external bleeding through massive self-inflicted injuries. A special feature of the findings was the intensity of the cuts to the wrist leading to subtotal amputation of the hand.

The bodies of a27-year-old woman and a44-year-old man were found lying entwined on their bed. Alarge-caliber revolver lay on the bed next to them. The forensic examinations at the discovery site and the subsequent medico-legal autopsies revealed afatal, sagittal gunshot wound of the thorax with atrajectory from back to front in the woman. The underlying man showed aretained projectile with asagittal bullet track from the entrance wound in the middle of the anterior chest wall to the spinal column. Examinations at the scene carried out to estimate the time since death showed consistent results for both persons with acoincident time of death approximately 7h before the time of examination. The results of the subsequently conducted toxicological investigations revealed an acute influence by exceptionally high concentrations of amphetamine in the woman and acombined intoxication with amphetamine, ecstasy and alcohol in the man. Both individuals showed metabolites indicative of previous cocaine consumption. In conjunction with the police investigations, the forensic medical findings strongly suggested an unusual case of double suicide.

Shaken baby syndrome (SBS) is awell-known phenomenon in the field of forensic and pediatric experts; however, there are difficulties and controversies when it comes to biomechanical reconstruction as neither experimental studies nor independent witnesses exist. Apossible source of information comes from perpetrators' confessions if available. We present two cases of confirmed SBS, where one includes abroad confession and the other contains an interview with the perpetrator who confessed to the crime. Both perpetrators reported similar social environmental situations (overwhelmed by crying children) and similar descriptions of how the child was handled (hands on both sides of the thorax, shaken back and forth). Both children ceased crying after being shaken and died despite medical treatment for the injuries.

In the pre-Christmas period a 37-year-old man was found lying lifeless on his bed by the duty nurse in an assisted living facility for handicapped persons. Numerous conifer leaves were found in the bed as well as in the mouth of the patient. The medical history of the man included pica, autism and a mild form of epilepsy. The medicolegal autopsy revealed layers of greenish needle-like leaves and twigs reaching from the lower part of the esophagus through to the colon. The autopsy findings showed no perforation due to foreign bodies, no signs of obstruction or other mechanical damage of the digestive tract or indications of a bolus death. Blood congestion of the internal organs as well as pulmonary and cerebral edema provided unspecific indications of poisoning. Due to the inconspicuous results of the systematic toxicological analysis, a targeted analysis for taxine from the yew tree (secondary pseudo-alkaloids in Taxus spp.) was performed by liquid chromatography tandem mass spectrometry (LC-MS/MS) using the method described by Frommherz et al. The total blood level of taxine B and isotaxine B was 236 mu g/l. This concentration confirms an acute poisoning and provides the explanation for the death as a result of oral intake of yew leaves.

Neonaticide is characterized by a range of special case circumstances. Whether or not a case is deemed to be a homicide can only be evaluated following autopsy and additional examinations. During autopsy external signs of maturity (e.g. physical attributes such as height and weight) should be validated and further specific autopsy techniques, such as lung floating tests should be considered. While the lung floating test is as relevant as ever, more recent developments in post-mortem examinations, as described in the literature impart richer detail. Utilization of medical imaging, most especially computed tomography (CT) scans, provides valuable information in cases of suspected neonaticide as it allows nondestructive examination and documentation of the actual state of the subject.

Shooting rampages have occurred sporadically in Germany in recent years and were examined forensically. They differ from terrorist assaults less in terms of sequence than in terms of motivation. The current article describes the forensic examinations that are necessary for complete clarification of an incident. Particular focus is placed on their organization, since the opportunity to answer questions that might arise later is determined or limited predominantly by decisions governing the sequence and scope of the examinations. On-site investigations; identification of afflicted persons; detection of injury patterns (in the living and the dead); investigation of the offender/suspect, including chemical-toxicological studies; consideration of the single acts; and a summarized analysis of the overall sequence constitute the spectrum of forensic investigation of rampage killings. All examinations are carried out in close cooperation with the investigating authorities. Only the availability of postmortem computed tomography, which is increasingly employed, has extended the range of methods. This has also significantly improved documentation of bone injuries and localization of projectiles. Inadequate investigations or examination conditions can be problematic if questions that were not considered primarily, and which were thus not adequately examined or were even neglected, are raised publicly at a later stage. Examinations of victims of rampage killings differ from other forensic investigations in terms of circumstances, but not in terms of content. Thorough, comprehensive (and, as such, also time-consuming) documentation of findings is obligatory.

Background. There has been a recent increase of requests for clinical forensic evaluation of torture survivors, not only in Germany. These evaluations can be challenging. Objective. The diagnostic and organizational characteristics, possibilities and unsolved issues concerning the clinical forensic evaluation of torture survivors are presented. Material and methods. After presenting a case report the characteristics of forensic evaluations in cases of alleged torture are discussed, taking particular account of the results of an interdisciplinary conference on this topic held in Dusseldorf on 10 and 11 March 2017 (http://www.folteropfer-sehen.de). Results. The documentation and evaluation of torture sequelae should follow the general standards of clinical forensic evaluations under consideration of the Istanbul protocol and should be performed only by trained examiners. Although they can have an essential impact on asylum procedures, forensic evaluations are only rarely commissioned by German state authorities. The organizational and financial burdens are often passed on to the affected persons or psychosocial institutions. Conclusion. Clinical forensic expertise can help to clarify cases of alleged torture. It is not acceptable that the financial and organizational burdens for such expertise are frequently passed on to the affected persons or psychosocial institutions, when they should actually be borne by the state authorities.

In the pre-Christmas period a 37-year-old man was found lying lifeless on his bed by the duty nurse in an assisted living facility for handicapped persons. Numerous conifer leaves were found in the bed as well as in the mouth of the patient. The medical history of the man included pica, autism and a mild form of epilepsy. The medicolegal autopsy revealed layers of greenish needle-like leaves and twigs reaching from the lower part of the esophagus through to the colon. The autopsy findings showed no perforation due to foreign bodies, no signs of obstruction or other mechanical damage of the digestive tract or indications of a bolus death. Blood congestion of the internal organs as well as pulmonary and cerebral edema provided unspecific indications of poisoning. Due to the inconspicuous results of the systematic toxicological analysis, a targeted analysis for taxine from the yew tree (secondary pseudo-alkaloids in Taxus spp.) was performed by liquid chromatography tandem mass spectrometry (LC-MS/MS) using the method described by Frommherz et al. The total blood level of taxine B and isotaxine B was 236 mu g/l. This concentration confirms an acute poisoning and provides the explanation for the death as a result of oral intake of yew leaves.

Neonaticide is characterized by a range of special case circumstances. Whether or not a case is deemed to be a homicide can only be evaluated following autopsy and additional examinations. During autopsy external signs of maturity (e.g. physical attributes such as height and weight) should be validated and further specific autopsy techniques, such as lung floating tests should be considered. While the lung floating test is as relevant as ever, more recent developments in post-mortem examinations, as described in the literature impart richer detail. Utilization of medical imaging, most especially computed tomography (CT) scans, provides valuable information in cases of suspected neonaticide as it allows nondestructive examination and documentation of the actual state of the subject.

Shooting rampages have occurred sporadically in Germany in recent years and were examined forensically. They differ from terrorist assaults less in terms of sequence than in terms of motivation. The current article describes the forensic examinations that are necessary for complete clarification of an incident. Particular focus is placed on their organization, since the opportunity to answer questions that might arise later is determined or limited predominantly by decisions governing the sequence and scope of the examinations. On-site investigations; identification of afflicted persons; detection of injury patterns (in the living and the dead); investigation of the offender/suspect, including chemical-toxicological studies; consideration of the single acts; and a summarized analysis of the overall sequence constitute the spectrum of forensic investigation of rampage killings. All examinations are carried out in close cooperation with the investigating authorities. Only the availability of postmortem computed tomography, which is increasingly employed, has extended the range of methods. This has also significantly improved documentation of bone injuries and localization of projectiles. Inadequate investigations or examination conditions can be problematic if questions that were not considered primarily, and which were thus not adequately examined or were even neglected, are raised publicly at a later stage. Examinations of victims of rampage killings differ from other forensic investigations in terms of circumstances, but not in terms of content. Thorough, comprehensive (and, as such, also time-consuming) documentation of findings is obligatory.

Background. There has been a recent increase of requests for clinical forensic evaluation of torture survivors, not only in Germany. These evaluations can be challenging. Objective. The diagnostic and organizational characteristics, possibilities and unsolved issues concerning the clinical forensic evaluation of torture survivors are presented. Material and methods. After presenting a case report the characteristics of forensic evaluations in cases of alleged torture are discussed, taking particular account of the results of an interdisciplinary conference on this topic held in Dusseldorf on 10 and 11 March 2017 (http://www.folteropfer-sehen.de). Results. The documentation and evaluation of torture sequelae should follow the general standards of clinical forensic evaluations under consideration of the Istanbul protocol and should be performed only by trained examiners. Although they can have an essential impact on asylum procedures, forensic evaluations are only rarely commissioned by German state authorities. The organizational and financial burdens are often passed on to the affected persons or psychosocial institutions. Conclusion. Clinical forensic expertise can help to clarify cases of alleged torture. It is not acceptable that the financial and organizational burdens for such expertise are frequently passed on to the affected persons or psychosocial institutions, when they should actually be borne by the state authorities.

Background:The objectives of this study were to create an objective measurement method of joint angles for knee, hock, front and rear pasterns and a rear stance position in swine using digital imaging technology and to assess the repeatability of the objective measurement process. Methods and Findings: Forty-five multiparous sows (average parity 6.7 ± 2.5; parity range 5 to 14) from two commercial farms (n=21 farm 1 and n=24 farm 2) were used. Sows were moved to a pen where digital images of the profile and rear stance were captured. On average, 5.2 (± 2.6) profile and 2.6 (± 1.0) rear stance high quality images were used per sow. A joint angle measuring system was devised to collect angle measurements on the four feet and leg joints previously mentioned and the rear stance. Joint measurements were analyzed using repeated measure mixed model methods, including farm and parity (as 5, 6, and 7+) as fixed effects. Intraclass correlation coefficients were calculated to evaluate process repeatability. Joint angle measurement repeatability ranged from 0.63 to 0.82. Lowest and highest repeatabilities were observed for the front pastern and hock angle measurements, respectively. No significant farm or parity differences were observed for joint angles measured except for the knee angle between farms (P<0.05) and the hock angle between sows’ parities 5 and 6 and parity 7+ (P<0.05). Conclusions: Feet and leg conformation evaluation using digital images could be successfully used as an objective tool to aide in selection of replacement gilts. This could have a beneficial impact on sow longevity and farm productivity and profitability.

Not infrequently, suicides or homicides are carried out by a sharp or semi-sharp tool through puncture, cut or slash injuries. Such tools have individual features through manufacturing and use that can leave individual-specific marks, especially during penetration of cartilage tissue, so that an unambiguous injury-tool assignment can be made. Since April 2012, in cooperation with the Department of Tool Marks of the Office of Criminal Investigation North Rhine-Westphalia (LKA NRW), Germany, tool marks in cartilage after puncture or cut injuries are secured by AccuTransA (R) casting material at the Institute of Legal Medicine Cologne. Together with the weapon in question, these casts are sent to the LKA NRW for a comparative tool-mark examination. Ten death cases have been included so far in the current project. In one third of the cases, the potential implements used in the crime could be clearly identified as the cause of the injury. The remaining studies provided inconclusive results. There were no false results. The casting of marks in human cartilage and possibly bones, for example by AccuTransA (R) casting material, and the tool-mark examination provide an easy-to-use method for exclusion or identification of the potential implements used in the crime as cause of an injury. In the absence of an alleged murder weapon, these analyses could help investigators make statements about the tool used. The cooperation between the LKA NRW and the Institute of Legal Medicine avoids the transport of body tissue because the casts on the injured cartilage are already taken on the autopsy table. The comparative tool-mark examinations are then carried out in the laboratory of LKA and rated by experts.

Not infrequently, suicides or homicides are carried out by a sharp or semi-sharp tool through puncture, cut or slash injuries. Such tools have individual features through manufacturing and use that can leave individual-specific marks, especially during penetration of cartilage tissue, so that an unambiguous injury-tool assignment can be made. Since April 2012, in cooperation with the Department of Tool Marks of the Office of Criminal Investigation North Rhine-Westphalia (LKA NRW), Germany, tool marks in cartilage after puncture or cut injuries are secured by AccuTransA (R) casting material at the Institute of Legal Medicine Cologne. Together with the weapon in question, these casts are sent to the LKA NRW for a comparative tool-mark examination. Ten death cases have been included so far in the current project. In one third of the cases, the potential implements used in the crime could be clearly identified as the cause of the injury. The remaining studies provided inconclusive results. There were no false results. The casting of marks in human cartilage and possibly bones, for example by AccuTransA (R) casting material, and the tool-mark examination provide an easy-to-use method for exclusion or identification of the potential implements used in the crime as cause of an injury. In the absence of an alleged murder weapon, these analyses could help investigators make statements about the tool used. The cooperation between the LKA NRW and the Institute of Legal Medicine avoids the transport of body tissue because the casts on the injured cartilage are already taken on the autopsy table. The comparative tool-mark examinations are then carried out in the laboratory of LKA and rated by experts.

Carbon monoxide (CO) poisoning either accidental or as suicide, is a common cause of death encountered in routine medicolegal autopsies. It is less well known that CO can also be formed from the resin in wood fibers. Wood pellets emit the highest amount of CO in the weeks following production. Insufficient ventilation, particularly during storage of freshly made wood pellets in storage bunkers for heating devices, therefore leads to accumulation of dangerous concentrations of CO. This article aims to alert the readership to the dangers of CO poisoning resulting from inappropriate storage of wood pellets. The dangers are exemplified by the case of a 43-year-old man who was found dead in a storage room for wood pellets. The cause of death was CO poisoning due to a blood carboxyhemoglobin concentration of 75 %. The findings were compared with 14 further fatal cases of asphyxia involving wood pellets and wood products published in the literature for the time period 2002-2014. The first scientific investigations on this phenomenon were carried out particularly in the USA, Canada, Sweden and China as large-scale producers of wood pellets and were included in the assessment of the literature. The evaluation of the currently available literature showed that the dangers associated with the storage of wood pellets as a purportedly harmless source of energy are to a large extent unappreciated and have already led to fatal accidents. Under this aspect it is conspicuous that due to the expansion of the market into private dwellings, private users have also suffered fatal accidents so that an official risk assessment with a clear and uniform identification of hazards appears to be necessary. The public awareness of the dangers resulting from the storage of wood pellets must be increased. Official, uniform danger markings and recommendations for handling (e.g. only entering a pellet bunker with a CO detection warning device and/or breathing mask) should be made public in order to

Carbon monoxide (CO) poisoning either accidental or as suicide, is a common cause of death encountered in routine medicolegal autopsies. It is less well known that CO can also be formed from the resin in wood fibers. Wood pellets emit the highest amount of CO in the weeks following production. Insufficient ventilation, particularly during storage of freshly made wood pellets in storage bunkers for heating devices, therefore leads to accumulation of dangerous concentrations of CO. This article aims to alert the readership to the dangers of CO poisoning resulting from inappropriate storage of wood pellets. The dangers are exemplified by the case of a 43-year-old man who was found dead in a storage room for wood pellets. The cause of death was CO poisoning due to a blood carboxyhemoglobin concentration of 75 %. The findings were compared with 14 further fatal cases of asphyxia involving wood pellets and wood products published in the literature for the time period 2002-2014. The first scientific investigations on this phenomenon were carried out particularly in the USA, Canada, Sweden and China as large-scale producers of wood pellets and were included in the assessment of the literature. The evaluation of the currently available literature showed that the dangers associated with the storage of wood pellets as a purportedly harmless source of energy are to a large extent unappreciated and have already led to fatal accidents. Under this aspect it is conspicuous that due to the expansion of the market into private dwellings, private users have also suffered fatal accidents so that an official risk assessment with a clear and uniform identification of hazards appears to be necessary. The public awareness of the dangers resulting from the storage of wood pellets must be increased. Official, uniform danger markings and recommendations for handling (e.g. only entering a pellet bunker with a CO detection warning device and/or breathing mask) should be made public in order to

Due to continuing modernisation, the number of automatic doors in routine use, including powered revolving doors, has increased in recent years. Automatic revolving doors are found mostly in department stores, airports, railway stations and hospitals. Although safety arrangements and guidelines concerning the installation of automatic doors are in existence, their disregard in conjunction with obsolete or incorrect installation can lead to fatal accidents. In this report, a 19-month-old boy is described whose right arm was caught between the elements of an automatic revolving door. As a direct result of rescue attempts, the child's body was drawn further into the narrow gap between elements of the door. To get the boy's body out of the 4-cm-wide gap between the fixed outer wall of the revolving door and the revolving inner, back-up batteries had to be disconnected so as to stop the electrical motor powering the door. Cardiopulmonary resuscitation was begun immediately after the rescue but was unsuccessful; the child was declared dead at the hospital he was taken to. The cause of death was a combination of compression-related skull and brain injury together with thoracic compression. This case shows an outstanding example of the preventive aspect as a special task of forensic medicine. Additionally, it serves as a warning for the correct installation and use of automatic revolving doors. Even so, small children should not use these doors on their own, but only with an alert companion, so as to prevent further fatal accidents of this sort.