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Model cannons are usually considered to be harmless toys; therefore no legal regulations are required. Nevertheless, suicidal intentions or playful experimentation can turn this toy into a lethal weapon. This paper describes two cases of misuse of model cannons, leading to severe injuries and consequently death: the first case was the result of a suicidal intention, where the cannon caused a bullet injury into the forehead with marked signs of close-firing and intensive brain damage. The second case was an accidental event, where the cannon induced an entry wound at the left chest wall with surrounding carbonization and a fatal rupture of the heart. Circumstances of the lethal situations and mechanisms of the cannons leading to fatal injuries including ballistic considerations are described. The report is supported by a thorough literature research., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Killings of human beings involving animals have rarely been described in the forensic literature. In the present case, the decapitated corpse of a woman as well as the decapitated, castrated and partially disemboweled corpse of a dog were found together. Both bodies also exhibited analogous, distributed massive sharp-force traumas. The approximately same pattern of actions as well as findings consistent with an exaggerated killing are particularly noteworthy. The perpetrator was found to be the son of the victim and had long exhibited psychological abnormalities. He was acquitted of the charge of manslaughter due to mental incapacity and was subsequently placed in a psychiatric hospital., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Suicides with chain saws and circular saws are extreme exceptions, in particular with regard to females and concerning the neck region. We report two of such rare cases involving young women. A 30-year-old female with a known schizoaffective psychosis killed herself with an electric chain saw. The autopsy revealed a deep saw cut of the neck and shoulder with partial transection of the cervical spine. Several tentative saw cuts were present on the right lower jaw. A 29-year-old woman suffering from depression committed suicide by use of a circular saw. She inflicted herself fatal neck injuries with at least three separate cutting procedures. Our cases were characterized by the following features: female sex, young adulthood, no occupational experience with saws, psychiatric disorders, absence of alcohol or drugs, use of an aggressive method of suicide, focus of saw injuries on the right side of the neck, detection of tentative saw cuts or several trials, identical causes of death (exsanguination and blood aspiration).

In 2006, 67 persons were killed in aircraft accidents in Germany and involving German aircrafts abroad. In spite of extensive investigation of each aircraft accident, there are no reliable data as to the number of suicides by aircraft. We report on a 50-year-old man who committed suicide by willfully crashing his Beech "Sierra" aircraft minutes after take off from an airport close to the town of Rendsburg, Germany. Before killing himself, the intoxicated pilot had sent an SMS announcing his suicide plans to a friend. The findings of the medico-legal investigation and the results of a review of aircraft accident reports by the German Federal Bureau of Aircraft Accidents Investigation (BFU) regarding suicidal plane crashes are presented.

Research on vitality and wound age estimation belongs to the classic fields in forensic medicine. Despite large literature data there is still considerable demand of further research and practical transfer of knowledge and techniques to daily casework. Scientific studies must fulfil basic criteria as to appropriate methods, selection of case material, analysis of results and quality control. Nowadays, immunohistochemistry, biochemical tests and molecular biological techniques are mainly used studying questions of vitality and wound age. Investigations can be based on human tissue samples (autopsy material, vital specimens) or animal experiments. The possibilities, advantages and disadvantages of these study designs are described. Indispensable is the use of appropriate control groups or control samples and a sufficient case number which permits statistical analysis. Main strategy is to minimize variations due to methods and investigators as the unavoidable biological variation of vitality processes and wound repair is large enough.

In continuation of former investigations on proinflammatory cytokines, in the present study the relevance of the transforming growth factors TGF-alpha and TGF-beta1 was evaluated for the diagnosis of vitality and wound age. Paraffin sections from human skin wounds due to sharp force influence, which had been collected in operations and autopsies, were investigated using immunohistochemistry. The wound age varied from a few minutes to a maximum of 6 weeks with focus on the early post-traumatic interval up to 5h. Samples from uninjured skin were available as controls. TGF-alpha (n=74) was weakly expressed in normal skin and showed a marked increase in epidermal reactivity after a wound age of approximately 10 min. The maximum was between 30 and 60 min. TGF-beta1 (n=51) revealed constitutional expression only in connective tissue. An increase of immunohistochemical reaction was partially detected even in classical stab wounds (wound age of several minutes). The immunohistochemically detectable signal concerned--presumably due to an infiltration with TGF-beta-rich thrombocytes--large parts of the traumatized skin and also the epidermal layers (cellular and interstitial marking). TGF-beta1 peaked after a post-traumatic interval of 30-60 min. Both factors, especially TGF-beta1, remained detectable in elevated levels also in older wounds with an age of days to weeks (network in granulation tissue). TGF-alpha and TGF-beta1 can efficiently contribute to the estimation of vitality and wound age based on the evaluation of cytokine patterns. In particular, this applies to TGF-beta1 because of its easier evaluation and rapid up-regulation. Similar to other cytokines, the parallel investigation of control skin from the same individual must be recommended to eliminate variation in the basal expression.

Today in modern times, traumatic injuries caused by crossbows are a rarity. The largest collection of cases so far is presented in this study, consisting of four fatalities (two homicides and two suicides) and two non-fatal injuries (grievous bodily harm and an accident). All the victims were male having an age between 31 and 54. The weapons, which were used, were mainly high-performance precision crossbows with telescopic sights and hunting bolts. The parts of the body involved were the facial/head area in three of the cases and the thorax in three of them. There were either deep or total penetration injuries to the cranium and thorax with the bolt remaining in the wound in four out of six cases. The persons with non-fatal crossbow injuries exhibited comparatively few symptoms, despite the sometimes extensive involvement of the interior of the cranium (cerebrocranial penetration, in one instance). The two cases of suicide favoured the body areas often found with gun-users. The aetiological classification of crossbow injuries may be difficult after the removal of the bolt. The external morphology is strongly dependent on the type of tip used. Multiple-bladed hunting broadheads produce radiating incised wounds, whereas conical field tips produce circular to slitlike defects. Correspondingly, the external injuries can be reminiscent of the effects of a violent attack by sharp force or of a gunshot wound. The possibility, supported by clinical data, that the victim might have the ability to act or even to survive for a period of time, even with penetration of the brain, should be taken into account when the cause of death is being investigated., (Copyright 2004 Elsevier Ireland Ltd.)

Unlabelled: The proinflammatory cytokines interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha) hold important functions in the early and late courses of inflammation, trauma and wound healing. In the present study, human skin wounds due to sharp force (n = 105) were collected during surgery and autopsy. The wound age mainly varied from several minutes to 5 h, some specimens aged up to 6 weeks. Control specimens from uninjured skin were available in each case. After preparation of cryostat sections, immunohistochemistry was performed according to the APAAP technique, using monoclonal and polyclonal antibodies. The results were evaluated semiquantitatively. All markers were weakly expressed in normal human skin constitutively. However, the staining pattern changed significantly in vital wounds concerning epidermal layers, subepidermal cells, vessels and sweat glands. IL-1beta and IL-6 showed enhanced expression after 15 and 20 min at the earliest (increase of epidermal reactivity). After 30-60 and 60-90 min, respectively, marked expression was observed with these markers. Similar alterations were detectable with TNF-alpha after 15 and 60-90 min. The reactivity of all three markers persisted over several hours, then decreased to basal levels again and sometimes reappeared after days and in granulation tissue. Leukocytes reacting with IL-1beta and IL-6 appeared after approximately 2 h., Conclusion: proinflammatory cytokines can serve as a useful tool for the estimation of vitality and wound age, in particular in the early post-traumatic interval prior to leukocyte reaction. Autolysis did not play a role in the samples investigated (postmortem interval up to 8 days). Problems could sometimes rise from constitutive expression. Therefore, it is recommended to examine control samples from the same individual and to compare the reactivity with wound specimens., (Copyright 2002 Elsevier Science Ireland Ltd.)

Proinflammatory cytokines play an important role in the mediation of inflammation and trauma. They could be useful for the determination of vitality and wound age. In the present study, 144 human skin wounds due to sharp force were investigated. The material was collected during operations (N=96) and postmortem examinations (N=48). The wound age varied from several seconds or minutes to 9 days. Control skin was available in each individual. The tissue specimens were homogenized and extracted in a solution of PBS and protease inhibitors. Interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-alpha) were measured by quantitative ELISA analysis. Statistical evaluation was performed by the t-test using the quotients of levels (wound sample/control skin). In surgical specimens the cytokine levels revealed a clear tendency to increase with wound age. IL-1beta in early skin wounds (24 h, P<0.05). The quantitative analysis of proinflammatory cytokines in wound extracts can contribute to the determination of vitality and wound age, in particular in the very early post-traumatic interval (classic stab wounds).

Pontocerebellar hypoplasia (PCH) is a very rare congenital (autosomal recessive) condition with fetal onset. Only a few cases have been published on the basis of both clinical data (symptoms/neuroradiological imaging) and autopsy results. This paper reports on such a case involving a 1.5-year-old male infant. The child suffered from severe psychomotor delay, extrapyramidal dyskinesia and epileptic seizures, but did not exhibit signs of spinal muscular atrophy as related to PCH type 1. Magnetic resonance imaging (MRI) at the age of 6 months demonstrated olivo-pontine and bilateral cerebellar hypoplasia. The boy was unexpectedly found dead. Autopsy disclosed a severe aspiration of gastric contents as the final cause of death. The neuropathological examination confirmed PCH type 2 (according to Barth [Brain Dev., 15 (1993) 411-422]) with marked microcephaly and olivopontocerebellar hypoplasia. Histologically, decreased density of olivo-pontine neurons, reduction of granular and Purkinje's cell layers of the cerebellum, slight astroglial proliferation and fragmented appearance of the dentate nuclei were observed. The immunohistochemical expression pattern was determined using antibodies against glial fibrillary acidic protein, synaptophysin and neurofilament protein. Summarizing, typical features of PCH type 2 were present and proved by clinical course, MRI and autopsy. Despite severe symptoms due to a natural disease this rare neurogenetic entity can become of forensic interest, when sudden unexpected death occurs.

Coronary embolisation is a very rare complication of the clinically widespread method of percutaneous transluminal coronary angioplasty (PTCA). The well-documented case of a 64-year-old male patient is presented comparing angiographic and morphological findings. The occluded left anterior descending artery (LAD) was successfully dilated during PTCA. Simultaneously the circumflex artery showed acute occlusion. The patient fell into cardiac shock and died after attempted resuscitation and agonal installation of extracorporeal circulation. The autopsy revealed severe residual stenosis of the proximal LAD by parietal thrombosis and occlusion of the proximal circumflex artery by an unattached intraluminal thrombus (0.8 x 0.3 x 0.2 cm) which had been dislocated during PTCA. Autopsy thus confirmed the clinical presumption of coronary embolism and, in addition, disclosed a previously unknown perforation of the femoral artery which had occurred during agonal installation of extracorporeal circulation and contributed to death via severe retroperitoneal hemorrhage. The case is discussed under the aspects of clinical quality control by forensic pathological investigations.

Fibronectin plays an important role in tissue repair and wound healing. Previous literature reports indicated that fibronectin could be a marker of vitality for wounds with a survival time of more than a few minutes. In order to verify these findings were performed immunohistochemical investigations on the expression of fibronectin in incised wounds of porcine skin inflicted into various anatomical regions in the early postmortem interval (0-5 min after circulatory arrest). Tissue specimens were collected 12-14 h postmortem and investigated for fibronectin on paraffin sections (alkaline phosphatase and monoclonal anti-alkaline phosphatase procedure). A markedly positive expression of fibronectin (not only next to the wound margin and clearly stronger than in normal undamaged skin) could be demonstrated in eleven out of 36 samples. A moderately positive fibronectin reaction was detectable in seven further specimens. Muscular contraction bands were observed in nine out of 36 specimens. The various reaction patterns of fibronectin cannot be finally explained, but are probably due to a passive transudation of skin tissue by blood components from injured vessels. As a result of these investigations the specificity and validity of fibronectin as a parameter of vitality has to be questioned. Fibronectin immunohistochemistry again reveals that the validity of parameters as vital criteria decreases when their manifestation time is short; postmortem/supravital induction seems to be possible resembling vital reactions in these cases.

Before an exhumation the question of its possible success usually arises. This paper aims to act as an aid by providing comprehensive lists ("expectation catalogues") of morphological and toxicological findings with their corresponding postmortem intervals. All organ systems are included. The results are based on the retrospective evaluation of 46 exhumations performed at the Cologne Institute of Forensic Medicine in a 20-year period (1974-1994) and a review of the literature. In our own material (34 males, 12 females, age range: 2 days-91 years) the postmortem interval varied from 6 days to 20.5 years. Exhumations were performed by order of criminal courts (n = 28), social insurances (n = 13) and private persons (n = 5). Main indications were problems of causality in social and civil law (n = 14), suspected intoxications (n = 10), possible medical malpractice (n = 7), criminal aspects of traffic accidents (n = 7) and identifications (n = 5). The expectation catalogues include the following remarkable items (with postmortem interval) from our own material: coronary thrombosis (3.5 months), granulation tissue in myocardial infarction (3.5 months), myocardial fibrosis (2.5 years), coronary sclerosis (7.5 years), femoral vein thrombosis and pulmonary embolism (3.75 months), pneumonia (3 months), pulmonary emphysema and chronic bronchitis (2.5 years); detection of strangulation marks (2 months); preservation of bone marrow histology (3 months), gastrointestinal tract in continuity (7.5 years), macroscopic and histological cerebral structures (17 years); toxicological detection of phenobarbital (6 weeks), CO-Hb (9.5 weeks), chlorprothixene (5.5 years), diazepam (7.5 years), furosemide (7.5 years) and parathion (E 605) (17 years). The cause of death could be clarified with sufficient certainty in 36/46 cases (78%). Exhumation problems could be answered completely in 39 cases and partly in seven further cases. On the whole this review again underlines the importance and value of this special kind of body examination even after long postmortem periods.

It was the aim of the present study to investigate whether the postmortem blood alcohol concentration (BAC) can be assessed by means of ethanol values measured in fluids from putrefactive blisters. Fluids from one or two putrefactive blisters were collected in 45 putrefied corpses (postmortem interval: 3-23 days, graduation of the degree of decomposition into four stages) and compared with femoral vein blood or femoral muscle. Ethanol and so-called putrefactive alcohols were determined in all samples by double GC-measurements. The results were converted to the medium water content of blood of 80%. The investigations revealed a significant correlation between the ethanol values of femoral blood/muscle and putrefactive blister fluid (PBF) (r = 0.725, P < 0.001). With the exception of one case, PBF values of 0.11% or more (n = 11) corresponded to minimum blood/muscle concentrations of 0.085%; PBF values of more than 0.15% (n = 8) corresponded to blood/muscle levels of at least 0.159%. Regression analysis revealed the formula BAC (in %) = 0.785 X ethanol (PBF) +0.011. Relevant concentrations of putrefactive alcohols such as 1- and 2-propanol and l-butanol only occurred in cases with far advanced decomposition. Ethanol levels determined in fluids from different putrefactive blisters of the same body also demonstrated a significant correlation (r = 0.791, P < 0.001). Ethanol concentrations determined in PBF must be judged with caution, but PBF values > 0.15% point to corresponding blood levels with a high degree of probability, at least where advanced putrefaction is excluded.

This is the first report in the forensic literature of a combination of fatal digoxin poisoning with endocardial fibroelastosis (EFE). Typical morphological features of EFE as the cause of clinically diagnosed cardiomyopathy were present in the autopsy of a 3-year-old girl, including cardiac hypertrophy and marked thickening of the left-sided endocardium, consisting of numerous elastic and collagenic fibres. After exclusion of cardiac and cerebral causes of death, accidental digoxin intoxication was proved. Postmortem toxicological analyses by fluorescence polarization immunoassay (FPIA) disclosed digoxin levels of 71 micrograms/kg (femoral vein blood), 77 micrograms/kg (cardiac blood), 255 and 221 micrograms/kg (cardiac muscle of the right and left chamber), 163 micrograms/kg (psoas muscle), 91 micrograms/kg (lung), 222 micrograms/kg (liver) and 520 micrograms/kg (kidney). The results are compared with the antemortem digoxin concentration of 39 ng/ml serum. The case is discussed from its unusual morphological and toxicological aspects, with special consideration of possible medical malpractice.

Unlabelled: It is frequently difficult to prove the vitality in cases of fatal hanging. Using impulse cytophotometry, Müller et al. (Krim. Forens. Wiss. 44, 1981) reported on possibly vital alterations of the DNA content in five strangulation marks (hypodiploidy). The objective of the present study was to perform a re-evaluation by means of current methods of quantitative DNA analysis. The investigation included 24 cases of hanging (typical, n = 11; atypical, n = 13). DNA was extracted by use of phenol/chloroform and quantitated photometrically in relation to the tissue weight. In addition, skin specimens were examined histologically and their water content was determined. The mean DNA content of strangulation marks was 3.2 micrograms DNA/mg tissue, that one of uninjured skin (control) 1.4 microgram DNA/mg tissue. The ratio of DNA content between strangulation grooves and control skin varied from 1.2 to 5.2 (average: 2.4) implicating apparently elevated DNA levels in strangulation marks. Histology revealed typical changes with absence of leukocyte infiltration suggesting mechanical compression of DNA containing layers. The additional determination of the water content emerged-in dependence on the macroscopic appearance, dried or non-dried-reduced values for strangulation marks (average: 42% vs. 66%). Statistical analysis demonstrated a significant correlation between elevated DNA content and reduced water content of strangulation marks., Conclusion: the markedly elevated DNA content of strangulation marks is interpreted as an artefact due to drying of the skin with a reduction of the water content (and weight) in the course of mechanical cutaneous alterations (compression). Therefore, quantitative changes in the local DNA content of the groove have no importance as a sign of vitality in fatal strangulations.

Unlabelled: It is in dispute whether the occurrence of numerous alveolar macrophages and in particular pulmonary giant cells in cases of fatal asphyxia is associated with agonal activation and proliferation. The nature of these alveolar cells was investigated in selected fatalities with protracted final oxygen lack using immunohistochemistry (APAAP method) and a semi-quantitative graduation. The study included opiate-involved deaths (n = 22), fatal strangulations (n = 10) and a control group of sudden cardiovascular deaths (n = 10). Positive immunohistochemical reactions were observed with the monoclonal antibodies PG-M1 (general marker of macrophages, detection of nearly 100% of pulmonary macrophages and giant cells in all subgroups) and 25 F 9 (late stage inflammation marker, detection of pulmonary macrophages/giant cells in 70%/50% of opiate-involved fatalities, 70%/20% of strangulations and 40%/30% of control cases). The antibodies LN-4 (macrophages), 27 E 10 (early stage inflammation marker), AMH 152 (activated macrophages) and MIB 1 (proliferation marker) did not react with these cell populations., Conclusions: pulmonary giant cells and numerous alveolar macrophages are not restricted to asphyxia. Their appearance is not of pathognomonic value for this diagnosis. Both cell types seem to be of heterogeneous nature (different functional state) as only one marker was expressed by all cells. The results do not suggest prefinal immigration, mobilization or proliferation of alveolar cells, but rather point to a longer pre-existence of macrophages and giant cells in pulmonary tissue (25 F 9 as late stage inflammation marker positive).

Rhabdomyomas of the heart are rare lesions and usually exhibit macroscopic tumour nodules at autopsy. The uncommon death of an apparently healthy 2 1/2-month-old female infant is described. Post-mortem examination revealed normal gross cardiac morphology and exclusively histological manifestation of multifocal rhabdomyoma. The microscopic and immunohistochemical features are demonstrated. Tuberous sclerosis, frequently associated with this type of hamartoma was not present. The case confirms again the importance of additional histological investigations in unexpected fatalities in infancy: beside the clarification of death, autopsy may obtain a prophylactic function in the detection of possibly genetically determined diseases such as cardiac rhabdomyoma.

After 50- to 200-fold concentration by ultrafiltration, 56 fresh urine samples from healthy individuals (26 men, 30 women) and eight samples from corpses were subjected to isoelectrofocusing methods. All the urine samples tested could be correctly typed in both the phosphoglucomatase 1 (PGM1) and Gc system when compared to reference blood samples. The activity of urinary PGM1 revealed intraindividual and interindividual variations. To our knowledge this is the first report of PGM1 detection in urine. A systematic storage experiment over a period of 6 months was carried out at different temperatures (-20 degrees C, 4 degrees C, 20 degrees C); furthermore, aging of urine samples from 4 months to 4 years was investigated. The heterogeneous typing results were as follows. For Gc: after a storage period of 6 months positive results could be obtained in approximately 40% of those samples that were stored frozen (-20 degrees C) or in a refrigerator (4 degrees C). Some samples, however, showed negative analyses already after a 1 month storage period. At room temperature positive results could be achieved up to 3 months. Additional bands can appear in pherograms of urine samples stored at room temperature or in a refrigerator; they may cause misinterpretation, dependent on the original Gc-type. The maximum storage time compatible with successful Gc-typing was 1 year. For PGM1: this polymorphism could be regularly detected up to 1 week, and in some cases up to 1 month, in urine samples stored at 4 degrees C. The PGM1 activity gradually decreased; there were no additional or variant bands.

Pulmonary histopathology was studied in a group of 106 fatal strangulations including cases of hanging (n = 55; typical, n = 20; atypical, n = 35), ligature strangulation (n = 12), throttling (n = 15), combinations of throttling and ligature strangulation (n = 7) and other compressing force against neck (n = 17). The control group (n = 10) consisted of cases of sudden cardiovascular death. The following results were obtained: intra-alveolar edema of different degree and strong hyperemia could be regularly observed in nearly all cases, especially in fatal hanging (apart from the control cases, in this group the highest mean lung weights were observed). Further frequent histological patterns were perivascular and intra-alveolar hemorrhages, local dystelectasis and focal emphysema. Alterations of the lung vessel contents could be detected in a varying extent: fat embolism (n = 7), mainly of minor degree, embolism of bone marrow tissue (n = 5) and intravascular cell accumulations (n = 22). Embolism of fat and bone marrow tissue was nearly always restricted to cases with accompanying blunt force or resuscitation measures. Whereas only 4 out of 55 cases of hanging revealed intravascular cell accumulations (including different types of leukocytes and immature bone marrow cells), 18 out of 51 cases with the other forms of strangulation exhibited this phenomenon. These accumulations mainly occurred in a discrete and widely scattered manner, appeared in 3 out of 10 control cases (resuscitation measures) as well, and were limited to cases with either protracted courses or accompanying blunt violence. The following conclusions are drawn: the regularly observed general changes of lung microstructure (e.g. edema, hyperemia) are undoubtedly non-specific for strangulation; the alterations of blood vessel contents may serve as a general vitality marker, if resuscitation measures are excluded, but not as an evidence of strangulating force. In cases without signs of blunt force they point to protracted agony courses (shock equivalents).