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Verletzungen der zentroaxialen (inneren) Hirnstrukturen sind ein nicht seltener Begleitbefund schwerer stumpfer Schadel-Hirn-Traumen (SHT) und werden seit Einfuhrung der Computer- (CT-) und Magnetresonanztomographie- (MRT-)Diagnostik in klinischen Studien haufig aufgefuhrt. Soweit sie Bestandteil einer disseminierten/diffusen allgemeinen Hirnschadigung sind, die auch unmittelbar lebensnotwendige Zentren betreffen kann, kommt ihnen klinisch keine herausragende Bedeutung zu. Das andert sich, wenn sie Quelle relevanter Blutungen in das Ventrikelsystem werden. Vorgelegt werden die Daten einer 676 Falle betreffenden makroskopischen neurophathologischen Untersuchung formalinfixierter Gehirne bei Todesfallen Erwachsener infolge stumpfer SHT der haufigsten Ursachen. Eine Beteiligung zentraler ventrikelnaher Hirnstrukturen war in 91 Fallen (13,5%) festzustellen. In 5 Fallen war es aus solchen zu Ventrikeltamponaden gekommen, allerdings nur in Fallen, in denen daneben weitere lebensbedrohliche intrakranielle Verletzungen erlitten worden waren. Isolierte innere Hirnverletzungen mit relevanten Folgen sind nach Angaben in der Literatur und auch dem eigenen Material Raritaten, die dann allerdings wegen der notwendigen Abgrenzung von Spontanblutungen erhebliche gutachtliche Schwierigkeiten bereiten. Dies wird an 2 Todesfallen mit erfolgter morphologischer Untersuchung und einem Gutachtenfall ohne Autopsiebefunde erlautert.

Die vorgestellte Auswertung umfasst 119 Falle von raumfordernden Subduralhamatomen (SDH), getrennt nach ihren Blutungsquellen: 45 aus Kortikalarterien, 29 aus Bruckenvenen und 45 aus Contrecoup-Verletzungen. Ziel der Untersuchung war es, Unterschiede und Gemeinsamkeiten hinsichtlich Einflussfaktoren, Verletzungsmustern und biomechanischen Komponenten zu erarbeiten. Alkoholismus und akute Alkoholisierung zum Zeitpunkt des Geschehens waren wie das Vorliegen einer Hirnatrophie in allen Gruppen annahernd gleich. Unterschiede fanden sich bei der Lokalisation von Kopfhautverletzungen; hierbei wiesen vaskulare Blutungsquellen haufiger exzentrische Gesichtsverletzungen und Contrecoup-Lasionen exzentrische Verletzungen der behaarten Kopfhaut auf. Hinsichtlich biomechanischer Komponenten konnten Contrecoup-Herde am ehesten einem Kontakttrauma mit fuhrend translatorischer Komponente zugeordnet werden. Dagegen war bei vaskularen Blutungsquellen und hier besonders bei denen aus Rindenarterien ein Nonkontakttrauma mit rotatorischer Komponente fuhrend. Von mitunter forensischer Bedeutung war die oft nur geringe Auspragung oder – bei SDH aus Rindenarterien in immerhin 2 Fallen – das vollstandige Fehlen von Hautverletzungen, die als Beleg fur eine traumatische Einwirkung angesehen werden und deren Richtung klaren helfen konnen.

In recent years, cardiopulmonary resuscitation (CPR) has been discussed as a cause of petechial hemorrhage in eyelids and conjunctivae, which could be of substantial significance to forensic expertises in cases of suspected strangulation. In the reported series or case observations, the combination of CPR and petechiae seemed to be sufficient to explain such a causal connection. Nearly all presented cases were victims for which the mechanisms resulting in death were themselves well-known causes explaining the development of such petechiae; and said mechanisms can frequently be observed in victims that did not receive CPR. An earlier, also retrospective, analysis of a series of forensic autopsies did not confirm CPR as a significant cause of conjunctival petechiae. Now we present the result of a prospective examination of 196 resuscitations of adult patients with separate assessment of petechiae being present even prior to resuscitation. Petechiae were present in 12 cases - but in eight of them prior to resuscitation already. Three other persons with petechiae found only after CPR were in the group of successfully resuscitated persons and exhibited petechiae hours after CPR during therapy in intensive care units - during a phase of ongoing cardiac insufficiency, which obviously caused them. The only case with petechiae observed neither immediately prior to nor after unsuccessful resuscitation, but during a follow-up examination one day later, needs to be discussed. It is not interpreted as reliable evidence for the causality of CPR though. Our interpretation of reports in literature as well as our experiences confirm the absence of actual proof of petechiae being generated by CPR and in the presence of generally significant doubts of this relation.

This review surveys subdural hematomas, including general knowledge presented in the literature as well as own experiences. Main topics are: frequency, causes, types, clinical symptoms, development, risk factors, prognosis of subdural hematomas and injured structures predominantly responsible for such bleedings. Focal points of the presentation are forensic aspects, not clinically important details. Generally, a reduction of the diagnosis as “subdural hematoma” seems to be problematic. Firstly a subdivision in “hematomas in patients with relevant injuries of the cerebral tissue” (like contrecoup-lesion) and “... without cerebral injury” (pure, respectively isolated) is necessary, because the predominant causes of such cases differ, and (forensic) experiences with one of these classes cannot be completely transferred to the other. Secondly, in pure subdural hematomas the source of bleeding, i.e. the type of injured vessel should be characterized - if ever possible. Ruptures of cerebral bridging veins are generally looked at as traumatically caused. In contrast, following clinical literature hemorrhages from cortical arteries sometimes occur spontaneously. This aspect seems to be not sufficiently discussed in forensic literature. An excursion to traumatic subdural hygromas rounds off this presentation.

In a series of 93 unselected forensic autopsies of adults the following volumes were measured: skull volume by filling a sac of synthetic material with water, placed intracranially, after removal of the brain and brain volume by its water displacement. Objective was to demonstrate if generally is there a relation between reduced difference of skull volume minus cerebral volume ("reserve volume"=RV, predominantly identical with cerebrospinal fluid compartment) and the presence of pressure marks (grooves) on the basis of temporal lobes (uncal grooves) and cerebellum (cerebellar cone). These alterations in post-mortem examination were usually regarded as signs of increased intracranial pressure during life. The obtained data were presented in diagrams. Most of the intracranial volumes were in the range 1200-1600 ml and brain volumes in the range 1200-1500 ml. The actual brain volume can be estimated by the multiplication brain weight *0.957. The RV in most cases was situated between 25 and 150 ml, corresponding 2-10% of the cranial cavity--increasing with increasing age of the persons. Clear uncal grooves (less distinct: cerebellar grooves) relate to significant decrease of the RV and the conclusion seems acceptable that this is indicative for intracranial displacement during life and is therefore an indirect sign of - at least local - brain swelling and increased intracranial pressure. However, to provide a well-founded basis for such a conclusion in a case under investigation a (semi quantitative) graduation of the intensity of such actual grooves seems to be recommendable.

Petechial hemorrhages or ecchymoses in the skin of the face and/or in eyelids and/or conjunctivae are one important feature in postmortem diagnosis of lethal strangulation. On the other hand, petechial bleedings can occur in various causes of death, especially in cases of neck or thoracic compression, they can occur in acute cardiac failure, as a result of blood or skin diseases or as a postmortem phenomenon. The focus of this investigation (retrospective study of 279 corpses, found initially in a prone position or some other face down position) was to analyse the frequency of postmortem (hypostatic) hemorrhages and factors which may influence their development. Petechial hemorrhages in livor mortis in the skin of the trunk and extremities were found in 110 cases (39%). The frequency ranged from 41% in the side position and 44% in the kneeling position to 50% in the prone position. Increasing intensity of livor mortis resulted in an increasing frequency of hemorrhages, up to 59%. In cases with a body-mass-index (BMI) of more than 26 the frequency of hemorrhages increased up to 64%. In cases without livor mortis when the corpses were found as well as in cases with complete movement of livor mortis after turning the corpses, no hemorrhages were found. If hypostasis was partly or completely fixed, the rate of hemorrhages increased up to 50%, without additional increase in longer postmortem intervals. Obviously postmortem petechiae develop neither very soon nor days after death, but within a period of several hours after death.

Suicides by ligature strangulation are rare events. In Berlin (3.5 million inhabitants; ca. 500 suicides per year) approximately one case per year occurs. Here, we present the main findings of 19 cases investigated between 1978 and 1998, compared to 47 cases of homicidal ligature strangulation. Two of the 19 suicidal victims had single fractures of the upper thyroid horns and one victim a fracture of a lower thyroid horn; other types of laryngohyoid injuries were not observed. In the homicidal series, the laryngohyoid structures were unaffected in 26 cases (12 of these victims were children or adolescents), single thyroid horn fractures were present in three cases and more significant injuries in 18 cases. Macroscopic bleedings of the laryngeal muscles were found in 12 victims of the homicidal group and in none of the suicidal. Bleedings in the neck muscles seldom occurred in suicides. According to these findings, the laryngohyoid injuries can be helpful in the differentiation of suicide from homicide, if more than a single thyroid horn fracture or a laryngeal soft tissue trauma is present.

The problems of assessment of aspiration (foreign bodies, stomach contents, food material) in forensic practical work are well-known, especially if 'suffocation due to aspiration' is considered to be the cause of death (or a concurrent cause of death). In the last 4 years (1998-2001) in the Department of Legal Medicine of the Free University, Berlin, 14 deaths with massive aspirations were investigated. The lethal aspiration cases consisted of seven men and five women between 55 and 91 years old, as well as two children (boy 6 years and girl 19 months old). All but one of the victims had severe neurological alterations (dementia, apoplexia, sequelae of head injuries). In six cases the victims died during or a short time after a meal; they had been fed by the nursing staff, a family member or another caregiver. The witness statements pertaining to clinical symptoms or the course of events ranged from 'no symptoms' to intensive cyanosis, congestion and no clear reactions of distress.

Zusammenfassung Es werden die Standardmethode der Kehlkopfpraparation bei der forensischen Obduktion sowie deren Unzulanglichkeiten bei geringfugigen morphologischen Veranderungen und Verletzungen beschrieben. Ein detailliertes Untersuchungsprotokoll fur Routine- und forensisch relevante Falle wird vorgestellt. Diese Sektionstechniken sollen sicherstellen, dass Verletzungen am Schildknorpel, am Ringknorpel und am Zungenbein entdeckt, dass Einblutungen der kleinen Kehlkopfmuskeln gefunden, und Kapsel- oder Gelenkblutungen der Kehlkopfgelenke nicht ubersehen werden und dass artifizielle Verletzungen, die zu Missinterpretationen fuhren konnen, ausgeschlossen werden.

Fragestellung. Angesichts einer kontroversen Diskussion in der Literatur, ob lebensbedrohliche intrakranielle Verletzungen mit Subduralblutungen bei Sauglingen (im 1. Lebensjahr) durch sog. Bagatelltraumen moglich sind, sollte eine Ubersicht uber todliche Falle dieser Art gegeben werden. Inhalt der Untersuchung waren keine Falle mit Schadelbruch und fokalen Hirnverletzungen, sondern isolierte Subduralblutungen. Methodik. Auswertung der amtlichen Todesursachenstatistik von Berlin (1978–1998) sowie des Obduktionsmaterial des Instituts fur Rechtsmedizin der FU Berlin (1978–1999). Ergebnisse. In der amtlichen Todesursachenstatistik findet sich kein einziger Todesfall eines Sauglings, der als Folge eines unfallmasigen Sturzes aus geringer Fallhohe angesehen wurde. In unserem Institut wurden 21 todliche Kopftraumen bearbeitet, von denen 10 den oben genannten Kriterien entsprachen; in keinem war nachvollziehbar von einem Bagatelltrauma auszugehen. Schlussfolgerungen. Die Kombination mehrere/multiple Bruckenvenenrupturen, Ausbleiben einer raumfordernden Subduralblutung und Koma oder Todeseintritt ist mit der Annahme eines unfallmasigen Bagatelltraumas nicht vereinbar.

This article gives a short overview of medical education in Germany. The legal basis and organization of the medical studies program as well as the course in forensic medicine and the training duration for forensic pathologists are described.

A 62-year-old man with a long history of lung disease developed atelectasis of the right middle lung lobe, caused by a protrusion in the wall of the middle lobe bronchus. A biopsy was performed in the suspicious region. This was immediately followed by massive arterial bleeding into the airways and complicated by cardiac arrest soon after. The bleeding could not be controlled by nonsurgical treatment; the patient died 24 h after the complication because of pulmonary insufficiency. Autopsy revealed the bleeding to have been caused by a biopsy injury of a bronchial artery that had run superficially in the bronchial mucosa and had produced the intrabronchial protrusion. Several other abnormal intrabronchial arteries were found peripherally in this lung.

Experimental data and clinical as well as postmortem experiences have indicated that subdural hematomas are less frequent in acceleration injuries in traffic accidents compared to falls or assaults. The present report demonstrates that this does not hold true in the same way for bridging vein ruptures (one of the predominant causes for subdural bleedings). Ruptures of these vessels without subdural bleeding (SDB) are only seldom mentioned in the literature. However, if no SDB is present, no one will look for these structures. In our institute a systematic analysis of the bridging veins in all cases of lethal blunt head injury is made: prior to the careful morphological preparation we investigate these vessels by radiographic imaging after filling with contrast medium. 6 car passengers (age between 4 and 31 years) which suffered a lethal head injury were examined in the last year. 2 victims had impressed fractures with cerebral compression injuries. In 1 case the base of the skull was broken and in 3 cases no skull fracture was present; no serious focal brain injury had occurred in these 4 cases, but 3 victims had signs of diffuse brain injury. In 5 cases a direct impact of the head against the interior of the car was obvious. In 5 cases ruptures of several bridging veins could be demonstrated. In one case (survival for 3 days) a minor SDB (20 ml) was present and the ruptures had been closed by thrombosis; another victim died at the scene. The other 3 victims survived between 4 and 15 hours without developing SDB and without closing of the ruptures by thrombosis. This combination is surprising and shows that our knowledge concerning the relationship between bridging vein ruptures and SDB is restricted. The frequency of bridging vein lesions in severe head injuries is likely underestimated in the clinical as well as in the postmortem literature. A rapid increase of intracranial pressure after the accident resulting in a collapse of the cerebral circulation is probably responsible for the absence of the SDB in the presented cases.

To expand the passive safety of automobiles protecting traffic participants technological innovations were done in the last decades. Objective of our retrospective analysis was to examine if these technical modifications led to a clearly changed pattern of injuries of pedestrians whose death was caused by the accidents. Another reduction concerns the exclusion of injured car passengers – only pedestrians walking or standing at the moment of collision were included. We selected time intervals 1975–1985 and 1991–2004 (=years of construction of the involved passenger cars). The cars were classified depending on their frontal construction in types as presented by Schindler et al. [Schindler V, Kuhn M, Weber S, Siegler H, Heinrich T. Verletzungsmechanismen und Wirkabschatzungen der Fahrzegfrontgestaltung bei Pkw-Fusganger-Kollisionen. Abschlusbericht im Auftrag der Deutschen Versicherungswirtschaft e.V. TU-Berlin Fachgebiet Kraftfahrzeuge (GDV) 2004:36–40]. In both periods more than 90% of all cars were from the usual types small/medium/large class. Hundred and thirty-four autopsy records of such cases from Department of Forensic Medicine (Charite Berlin) data were analysed. The data included technical information of the accidents and vehicles and the external and internal injuries of the victims. The comparison of the two periods showed a decrease of serious head injuries and femoral fractures but an increase of chest-, abdominal and pelvic injuries. This situation could be explained by an increased occurrence of soft-face-constructions and changed front design of modern passenger cars, resulting in a favourable effects concerning head impact to the car during accident. Otherwise the same kinetic energy was transferred to the (complete) victim – but because of a displacement of main focus of impact the pattern of injuries modified (went distally).

Fragestellungen: Lassen sich neben dem bekannten Faktor „Todesursache“ weitere Faktoren ermitteln, die die Entstehung petechialer Blutaustritte im Kopfbereich begunstigen? Gehoren kardiopulmonale Reanimationsmasnahmen (REA) hierzu? Material, Methode: a) Auswertung von 473 fortlaufenden, fur die Fragestellung geeigneten Obduktionen eines Untersuchers. Ausgenommen blieben faulnisveranderte Leichen, Bauchlagefalle, Leichen mit gravierenden Gesichtsverletzungen durch Feuer oder stumpfe Gewalt und (mit Ausnahme von Ertrinkung) Erstickungs- sowie Strangulationsfalle; b) Analyse von 181 Herztodesfallen des Institutes (alle Untersucher). Ergebnisse: Petechien fanden sich in 13,3% aller Falle, mit deutlicher Abhangigkeit von der Todesursache: bis zu 31% bei Brandtodesfallen, Intensivpflegepatienten und kardialen Todesfallen. Bei im mittleren Lebensalter Verstorbenen waren Petechien deutlich haufiger (> 20%) als bei alten Personen (< 10%). Mit zunehmender Korpermasse stieg der Anteil an Fallen mit Petechien an und war bei extrem adiposen Personen wieder geringer. Auch mit Zunahme des Herzgewichtes stieg die Frequenz beobachteter Petechien. Vordergrundig scheint ein Zusammenhang zwischen REA und Petechien vorzuliegen: Bei Todesfallen ohne REA fanden sich petechiale Blutungen in 11%, bei REA in 19% (χ2: p < 0,05). Dieser (dann aber nicht mehr statistisch signifikante) Unterschied war jedoch nur bei solchen Todesursachen vorhanden, bei denen Petechien ohnedies haufig sind (insbesondere Koronartod), und auch nur bei jungeren, nicht jedoch bei alteren Personen. Bei vielen anderen Todesursachen bestand dagegen keine Differenz in der Inzidenz von Petechien mit bzw. ohne REA. Schlusfolgerung: Neben der Todesursache spielen weitere Faktoren (Alter, Korpermasse, moglicherweise auch das Herzgewicht) bei der Entstehung von Petechien eine Rolle. Reanimationsmasnahmen werden demgegenuber nicht als eigenstandiger Kausalfaktor fur die Entstehung petechialer Lid- und Konjunktivalblutungen angesehen.

Im Marz 1997 wurden alle 459 in Berlin praktizierenden Chirurgen und Orthopaden schriftlich nach ihren Erfahrungen mit atraumatischen und posttraumatischen HWS-Beschwerden befragt. Der Rucklauf betrug rund 25%. Bemerkenswerterweise beeinflusten personliche Unfallerfahrungen (als Fahrzeuginsasse) die Sichtweise der Arzte: von den 26 Arzten mit eigenen posttraumatischen HWS-Beschwerden hielten 54% eine solche Symptomatik fur traumaspezifisch, wahrend dies nur 35% der 40 Arzte mit Unfallen, aber ohne HWS-Beschwerden so sahen. 22% der Arzte ohne Unfallerfahrung gegenuber 62% der Arzte mit bezogen auf die HWS folgenlosem Unfall gaben an, materielle Begehrlichkeiten von Patienten wurden haufig in Symptomatik und Behandlung eine Rolle spielen. Angesichts seiner speziellen Beziehung zum Patienten sowie aufgrund der typischen Befundarmut des Beschwerdebildes hat es der behandelnde Arzt allerdings schwer, von ihm u. U. als uberzogen empfundenen Begehrlichkeiten entgegenzutreten.

Im Gegensatz zu vielen klinischen Angaben gibt es von pathologisch-anatomischer Seite keine uber bei verschiedenen postmortalen Fallgruppen beobachtete Fullungsvolumina der Gallenblase (GBV). Es sollte ein Vergleichsmaterial zu verstorbenen Krankenhaus- und vor allem Intensivpflegepatienten erarbeitet werden, bei denen abnorme GBV haufig sind. Basis waren 628 fur die Fragestellung geeignete Falle einer fortlaufenden Serie gerichtlicher Obduktionen 1988–1995. Das Untersuchungsgut war durch einen hohen Anteil geringen GBV charakterisiert: in 72% der Falle wurden 10 ml nicht uberschritten. Die Mittelwerte des GBV betrugen im Gesamtmaterial 11,8 ml (m: 12,9 ml; w: 9,6 ml). Ohne klaren Einflus waren eine blande Cholelithiasis sowie eine hohe Korpermasse (Body Mass Index). Mit zunehmendem postmortalen Intervall stieg der Anteil kaum gefullter GB etwas an. Die niedrigsten GBV fanden sich bei akuten Todesfallen (Koronartod: 8,7 ml; stumpfe Gewalt: 6,3 ml), deutlich hohere bei Intoxikationen (11,2 ml), ubrigen naturlichen Todesfallen (12,1 ml) und chronischen Alkoholikern (17,6 ml). Die GBV lagen deutlich unter den an Lebenden gewonnenen Volumina. Ein postmortaler Flussigkeitsverlust wird ebenso diskutiert wie eine von der Agonieform abhangige (Teil-)Entleerung im Todesgeschehen.

Reported is the case of a 36-year-old man with neurofibromatosis type 1 with lethal haemorrhage from rupture of the left common iliac artery. Histologically and immunohistochemically, no hints on angiodysplasia as a possible cause of bleeding were detected. Considering the literature and the histological findings in the area of rupture, a local weakness of the vascular wall caused by the neighbouring neurofibromatous proliferates was most probably the reason for bleeding.

Subdural hematomas (SDH) are a frequent autopsy finding in victims of closed head injuries. About 2/3 of the cases in our own massive SDH series had brain contusions as a cause of bleeding. In about 1/3 of the cases, SDH resulted from ruptured vessels of the brain surface in the absence of contusions. Our experience has shown that such an "isolated" SDH may be expected in about 5% of fatal blunt head injuries. A technique is presented to detect bridging vein leakage before there is any risk of artificial damage. After sawing through the skull in the fronto-occipital plane and cutting through the upper half of the brain together with the calvarium, approximately 5-10 ml of barium sulfate are instilled into the superior sagittal sinus by a balloon catheter at low pressure, and X-rays are taken. If there is extravasation, the rupture is visible before further preparation.

Report of a suicidal mono-intoxication with the class IC antiarrythmic drug propafenone. A 20-year-old female physician's assistant secretly ingested the substance (presumably 20 tablets per 300 mg) about 4-6 h before her death, and in the interim remained under the supervision of her physician. An ECG taken about 1/2-2 h after ingestion showed widening of the QRS complex and signs of an acute load of the right ventricle; the clinical symptoms were nausea, vomiting and hypotonia. After about 4 h without serious symptoms acute loss of consciousness and cardiac failure occurred, resuscitation efforts remained unsuccessful. At autopsy propafenone was found in blood (12 micrograms ml-1), liver (60 micrograms g-1) and cardiac muscle (11 micrograms g-1).

Autopsy findings and neuropathological examination of formalin-fixed brains in 676 deaths due to blunt head injury, here with special attention to injuries of the inner (periventricular) cerebral structures and haemorrhages into the ventricles. Intraventricular haemorrhage of any degree was present in 17.6%, considering only distinct and massive haemorrhage in 10% of all cases. Considering the types of trauma, the frequency was lowest in ground level falls and highest in traffic accidents (pedestrians with head contact to the car) - indicating a relation between the severity of impacts and the likelihood of ventricular haemorrhage. They predominantly resulted from periventricular injuries (27%) or retrograde expansions of infratentorial lesion with subarachnoid bleeding (19%), from massive contrecoup lesions (14%) or deep intracerebral ruptures (13%). In cases with predominant lesions of the cerebral surface the rate was lower than in those with more diffuse or internal damages. Injuries of the internal cerebral regions (away from cortex and subcortical white matter) were classified into those directly affecting the periventricular structures (9.1-13.5%; half of them affecting corpus callosum and/or fornix) and lesions of deep white matter or basal ganglia not adjoining the ventricular walls (4.0-5.9%). Intraventricular haemorrhage as well as injuries of the inner cerebral structures mostly are one element of a complex and severe blunt head injury. Solitary lesions - without other intracranial findings clearly indicating a trauma and therefore cases producing difficulties in forensic classification (spontaneous? traumatic?) - are rarities according to literature as well as our experiences.

OBJECTIVE: Although the literature concerning subdural hematomas (SDHs) is vast, few data are available as to the sources and related clinical differences of SDHs. Pure SDHs of arterial versus venous origin should be compared in terms of cause, size, space-occupying effect, and form. METHODS: We analyzed data from 46 patients who died as a result of pure SDHs. Twenty-three SDHs resulted from bridging vein ruptures and 23 from torn cortical arteries. We performed a morphometric analysis of the intracranial situation on the horizontal plane at the level of the greatest fronto-occipital diameter. We included in our analysis the clinical one-dimensional parameters (e.g., hematoma thickness, midline shift); the areas of the hemispheres, the SDHs, and their displacement; and the hematoma volume. RESULTS: Most of the investigated postmortem characteristics of both types of hematomas were similar, with the exception of the form and the midline shift. SDHs resulting from arterial ruptures (which are generally located in the temporoparietal region) differ in form from those caused by bridging vein ruptures (which typically rupture in the frontoparietal parasagittal region). CONCLUSION: The form difference allows the probable rupture site to be estimated; this observation might prove useful for clinical purposes.

Fractures of the upper thyroid horns are a frequent finding after a variety of neck injuries - resulting from a direct mechanical trauma, e.g. compression of the neck in manual strangulation or ligature strangulation, from blunt injuries (falls or blows against the neck), and sometimes from indirect trauma (whiplash-injuries). Although it is well known that thyroid horns can be broken with relatively little pressure, no quantitative data are available in the literature. In an experimental investigation, the isolated thyroid cartilage was prepared (divided into two parts, measured, X-rayed, photographed, embedded in paraplast) and clamped in a simple apparatus. Weight was applied on the upper thyroid horn (imitating pressure on the horns), beginning with 1 kg and gradually increased by increments of 250 g to a maximum of 8 kg, until an 'injury' occurred. In this study, 120 thyroid cartilages (77 men, 43 women, 16-95 years) were investigated. The location of the fractures was in nearly all cases the base of the horns. The mean weight resulting in an injury of the horn was 3 kg (men: 3.3 kg, women: 2.6 kg). The required weight was dependent on the degree of ossification. The highest rate of fractures was found in cases with incomplete ossification; in cases without ossification, specimens often remained macroscopically uninjured.

In the usual method of brain removal in forensic autopsies, the upper bridging veins were invariably torn. There are several types of head injuries, in which ruptures of these vessels are the predominant intracranial injury. For the past 5 years we have investigated nearly all cases of lethal head injuries by a simple X-ray method (axial X-ray after instillation of contrast material into the superior sagittal sinus). The evaluation of the 350 X-rays which were available until today can be summarized by the following statements. (a) Anatomy of the parasagittal bridging veins: regarding the numbers and diameters of the veins, we can separate cases with many bridging veins of small diameter from a group with few veins of a large diameter. (b) Causes of injury and direction of impact: bridging vein ruptures resulted more often from frontal than from occipital, parietal and lateral impacts and occurred in traffic accidents in the majority of our cases.

We compared the lungs of six drowned and six non-drowned persons over 70 to determine whether there is evidence of acute overinflation in drowning that can be distinguished from senile lung emphysema. All left lungs underwent intrathoracic formalin fixation to preserve their state of insufflation. To assess the effects of lung collapse, all right lungs were sectioned as usual and then immersed in formalin. After histological processing, microphotography and image processing of 12 specimens per corpse, 50 binary images of each specimen were measured by computerized morphometry. Intrathoracic fixation resulted in significantly less tissue area (and more airspace) in the left than in the right lungs of both groups. Comparing both groups' left lungs revealed that the interalveolar septa were thinner and the area occupied by connecting nodes smaller in drowning; these single nodes also tended to be smaller. There was a tendency for less alveolar tissue area per image in drowning than in control lungs and for narrow tissue structures to comprise a higher percentage of both the total tissue area and total tissue perimeter per image. We conclude that there is morphological evidence of acute overinflation even in senile lungs, but this is masked by postmortem lung collapse as suggested by the overlapping values of the right lungs. Support to the diagnosis of drowning among drowned elderly patients can only be available in lungs subjected to intrathoracic postmortem fixation.

congenital diaphragmatic hernia (CDH) in the prediction of neonatal survival. Methods: Between January 2006 and December 2009, the lung-tohead ratio was evaluated before and every two weeks after FETO in cases of severe isolated CDH (LHR

Case report on a suicide with a gas pistol loaded with 8 mm blank cartridges. A 58-year-old male shot himself in the right temple and then in the back of the neck. The contact shot wounds showed large wound cavities with interspersed powder particles. The soft tissues were injured solely by the pressure of the exploding powder. Death was due to an air/gas embolism in the right ventricle of the heart.

Hemorrhages of the tongue can be useful for the diagnosis in cases of lethal neck compression. The reported frequencies of tongue bleedings in the literature in cases of suicidal hanging range from 0 to 14% and in homicidal strangulation (str.) from 5 to 37%. This study gives a summary of the incidence and intensity of tongue bleedings in cases of homicidal str. by ligature, manual str., suicidal str. by ligature and suicidal hanging. In 25% of all homicides significant or massive hemorrhages of the tongue were detected. In contrast to this, in suicidal hanging the tongue was unaffected in 95%. The causes of massive hemorrhages here (2%) could be explained by an “abnormal” position of the loop.

Are any other factors besides the factor "cause of death" involved in the development of petechial hemorrhages (PET) of the head? The significance of the cause of death is well known, other factors have been rarely investigated in medical literature. Do they include cardiopulmonary resuscitation (CPR), as has been claimed in several forensic publications?(a) 473 consecutive autopsy cases (without strangulation) evaluated by one examiner, which were appropriate for this investigation; (b) analysis of 181 cardiac deaths (investigated by all physicians of our institute).Petechiae were found in 13.3% of all cases and were clearly dependent on the cause of death, up to 20% were found in burn victims, intensive-care patients and cardiac fatalities. Petechiae were more frequently observed in the middle age groups (20%) than in old persons (10%). The number of PET cases increased with body mass but was lower in extremely obese persons, a greater number of cases with PET was also observed with increasing heart weight. PET were observed in 11% of the deaths without CPR compared to 19% with CPR. This difference was predominantly caused by the subgroup "acute coronary death", especially if victims younger than 60 years were considered, whereas in many other causes of death no difference in the prevalence of PET with or without CPR could be observed.Besides the cause of death, other factors (age, body mass and possibly even heart weight) influence the development of petechiae. The hypothesis that CPR alone produces PET is not confirmed by our experience.

This case reports on a fatal craniocerebral trauma involving numerous ruptured cerebral bridging veins that did not bleed subdurally, despite approximately 15 hours of survival. A 15-year-old girl was severely injured as the passenger of a car that crashed sideways into a tree. She-suffered a cerebral trauma of the "diffuse injury" type and was unconscious after the accident. Her computed tomographic scan at admission showed massive brain edema, axial herniation, and marked hypodensity of the bilateral carotid flow area. Despite intensive care measures, the clinical course was characterized by central decompensation with therapy-resistant cardiocirculatory insufficiency. The autopsy revealed ruptures of numerous parasagittal bridging veins. The injured vessels were not thrombosed, and yet there was absolutely no subdural bleeding. This unusual combination of findings is assumed to be caused by an isolated collapse of cerebral circulation occurring shortly after the accident and primarily attributed to a rapid increase of intracranial pressure.

In a frontal collision of a car (taxicab) perpendicular into a streetcar with an impact speed of approximately 30 kph (20 mph), the driver survived with minor injuries. The front-seat passenger was extremely "out-of-position," with her seat positioned nearly fully forward. This in combination with her short stature led to fatal injuries resulting from the inflating airbag (U.S.-type) striking against her face and chin. At the scene, she was found essentially clinically dead, but was resuscitated and died finally 13 days later. Postmortem examination showed a complete disruption of all ventral ligaments between the base of the skull and the first and second vertebrae, a nearly complete ventral rupture of the medulla, and diffuse axonal injury of the brain.

We report a homicide involving the use of a motor vehicle and simulating a traffic accident. This observation was the reason for a retrospective analysis of neck injuries in victims of traffic accidents, in which a person has been run over (RO) by a motor vehicle. The autopsy material of two institutes from 1990-1996 was used. The following findings were obtained in 63 victims: laryngohyoid fractures (LH-fx): 10 cases (16%) with a clear difference between the institutes (22% versus 7%). This resulted from examination with special regard to such injuries in many cases at one of the institutes, whereas only autopsy reports were taken retrospectively from the other institute. Five of these cases had suffered only minor LH-fx (as seen frequently in strangulation), although extensive run over (RO) injuries of the other cervical tissues were present. All LH-fx were caused by direct compression of the neck; in eight of the cases they were combined with mandibular fractures. Petechial hemorrhages (petH) at the eye lids/conjunctivae were seen in 19 cases (30%); 16 of these were related to thorax RO injuries, three to abdominal RO only. Four cases involved LH-fx, petH as well as cervical skin lesions and additional cervical soft tissue hemorrhages. Interpretation can be extremely difficult with this combination of findings if the character of the event cannot be established as accidental beyond doubt on the basis of the circumstances.

These studies were designed to demonstrate that the usual method of laryngeal dissection carries a significant risk of overlooking important laryngeal injuries. Formalin-fixed hyoid-larynx complexes were prepared in a prospective forensic study involving 191 cases of homicidal strangulation, 1984 to 1997. The basic steps of the applied method included: complete resection of the thyroid cartilage, a horizontal incision through the cricoid cartilage before opening the larynx dorsally, inspection of the laryngeal joints, and incisions of the laryngeal muscles. Using this procedure allowed us to detect the following injuries, which otherwise would have been destroyed or overlooked: (a) 17 incomplete fractures restricted to the dorsal surfaces of the thyroid laminae and 10 incomplete or non-dislocated fractures of the cricoid cartilage. In 7 cases, such a "hidden" fracture was the only laryngeal injury resulting from neck compression. (b) Extensive laryngeal muscle hemorrhages, especially of the vocal folds, were found in almost half of all cases, more rarely in strangulation by ligature and more frequently in manual strangulation. Gross hemorrhages were the decisive local laryngeal finding in 19 cases. (c) Laryngeal joint injuries (bleedings) were found in 18% to 52% of the different strangulation types. (d) Hemorrhages of the laryngeal mucosa were common findings that occur in about 60% of all cases; only in rare cases do such bleedings have a special diagnostic value. The quantity and significance of findings obtainable from complete preparation clearly document Camps's demand made in 1976 to dispense with the usual laryngeal dissection technique (dorsal scissor incision through the cricoid cartilage), at least in (questionable) strangulation cases.

Bei einem 44jahrigen Patienten kam es bei der Sondierung der intrahepatischen Gallenwege mit einem Fogarty-Katheter im Rahmen einer Cholecystektomie wegen Cholecystolithiasis zur Perforation eines Seitenastes des D. hepaticus dexter und einer kleinen Lebervene, so das eine biliovenose Fistel entstand, uber die wochenlang ein erheblicher Galleeinstrom in das Blut erfolgte (Serumbilirubin max. 742 μmol/l). Trotz klinischer Diagnose der Fistel und intensiver Bemuhungen gelang es nicht, den todlichen Ausgang abzuwenden. Infolge der Bilhamie kam es zur schweren cholamischen Nephrose, zum Nierenversagen, spater zur Gerinnungsstorung, zur Atem- und Kreislaufinsuffizienz und schlieslich zum therapie-resistenten Schock.

Ein 47jahriger Mann wurde zu Boden geschlagen und liegend gegen den Kopf getreten (linksseitige Gesichtsschadelfrakturen); alsbaldige Bewustlosigkeit und bei Klinikeinlieferung Diagnose eines Hamatocephalus internus. Trotz Drainagen massive Hirndrucksteigerungen, Hirntod nach 8 Tagen. Quelle der todlichen Subarachnoidalblutung mit Einbruch in die Ventrikel war eine fast vollige Zerreisung der linken A. cerebelli inf. post; an der Rupturstelle war ein traumatisches Aneurysma in Entstehung. Die kontralaterale A. vertebralis zeigte im Bereich C1 und C2 ein ausgedehntes obturierendes dissezierendes Aneurysma sowie Wandrisse des Hauptstammes und eines Muskelastes.

In the preceding publication (see p. 1) the question arose of how to explain the longitudinal tears of the vertebral arteries at the departure of the posterior inferior cerebellar artery, that occur as origin of fatal subarachnoidal hemorrhage subsequent to blunt forces against the head. As the result of calculation of flow dynamics in a right-angled branching a curvature of the main vessel opposite to the flow in the branch develops. If the main vessel is unable to evade, the branch will be impressed into the main vessel in a piston-like manner. An experiment with silicon tubes succeeded to produce longitudinal tears resembling to those described by Krauland. Traumatic increase of pressure and stress of the vessels are considered the most likely cause of longitudinal ruptures of the basal arteries.

Anhand von 265 histologisch untersuchten Kehlkopfpraparaten gerichtlicher Obduktionsfalle (darunter 73 Totungen durch Strangulation; 93 ubrige gewaltsame sowie 79 naturliche Todesfalle) werden die Phanomenologie, die Haufigkeit und die Altersabhangigkeit als degenerativ imponierender Veranderungen im M. cricoarytanoideus posterior untersucht. Bereits in mittlerem Lebensalter zeigt ein groser Anteil der Falle Kernanomalien, Faserdestruktion, z. T. auch Atrophien; Veranderungen, die zumindest in dieser Auspragung an anderen Kehlkopfmuskeln (und an der ubrigen Skelettmuskulatur) nicht beobachtet werden konnen. Es handelt sich um Folgen einer dauerhaften Uberbeanspruchung (Alterungsprozes); der M. posticus ist offenbar ferner gegenuber verschiedenen Schadigungen besonders empfindlich. Den degenerativen Befunden kommt wohl keine wesentliche klinische Bedeutung zu; sie mussen aber berucksichtigt werden, wenn (mikroskopische) Folgen akuter Insulte am Kehlkopf bewertet werden sollen.

Ausgehend von der Untersuchung mehrerer Totungsdelikte mit Verschlus der Atemoffnung der Opfer durch Sand wurden Modellversuche zur Atmung durch verschieden dicke Sandschichten (bis 90 cm) mit Kontrolle der Atemgase und des Druckes sowie zur Frage des Umfanges der Sandaspiration in solchen Fallen durchgefuhrt. Es kommt auch schon bei dunner Sandschicht (15 cm) zur Totraumventilation mit der in der Sandschicht in unmittelbarer Nahe der Atemoffnungen befindlichen Luft mit Anstieg der CO2- und Abfall der O2-Konzentration. Auch bei 90 cm dicker Schicht sind noch Atemvolumina von bis zu 31 moglich. Das Ausmas einer Sandaspiration hangt in erster Linie von der Feuchtigkeit des Sandes ab: schon bei einem Wassergehalt von rund 5% kann sie fast vollig ausbleiben.

Detaillierte Beschreibung von drei Totungsdelikten, bei denen ein Verschlus der Atemoffnungen durch Sand oder Erde (ohne gleichzeitige Verschuttung des ganzen Korpers) als zum Tode beitragende Bedingung zu erortern war. Tabellarische Ubersicht der Umstande und Befunde von zwei weiteren Totungsfallen sowie sechs Unglucksfallen durch Verschuttung. Wei bei anderen Erstickungsarten kann die Todesursache meist nur indirekt abgeleitet werden. Bei aufgrund der Fundsituation oder eines Aspirationsbefundes anzunehmenden Erstickungsvorgang entstehen unter Umstanden Schwierigkeiten der Abgrenzung bei weiteren, potentiell todesursachlichen Verletzungen. Histologische Untersuchungen konnen unter gunstigen Bedingungen die Reihenfolge verschiedener Einwirkungen klaren helfen. Im Hinblick auf vitale Reaktionen auf den Erstickungsvorgang ergab die Histologie in einigen Fallen bemerkenswerte Befunde, jedoch kein insgesamt einheitliches Bild. Sandpartikel werden (auch bei freier Thoraxexkursion) nur in geringem Umfang aspiriert. Dem subtilen, auch topographische Gesichtspunkte einschliesenden Nachweis des Fremdmaterials in Atemwegen und Lungen kommt eine besondere Bedeutung zu. Bei der Interpretation dieses Befundes wird eine Unterscheidung, ob es sich um ein nicht entscheidendes, agonales Aspirieren oder um einen todlichen Erstickungsvorgang gehandelt hat, auserordentlich schwierig und manchmal auch nicht sicher moglich sein.