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Mittelbare Verletzungen der A. vertebralis sind beim Schutteltrauma des Sauglings und auch als Sturzfolgen forensisch gelaufig. Dagegen scheint die Frage einer Schadigung der A. vertebralis als Komplikation einer Therapie zunachst nicht naheliegend. Ausgehend von den Befunden zweier im Schrifttum mitgeteilter Todesfalle von Sauglingen nach durchgefuhrter Vojta-Physiotherapie mit schweren hypoxischen Schadigungen des Gehirns im vertebrobasilaren Stromgebiet werden auch manualmedizinische Techniken auf strukturelle Gefahrdungen der A. vertebralis hin untersucht. Die Vergleiche stutzen sich auf mitgeteilte anatomische, biomechanische und klinische Daten. Danach besteht bei durchaus gebrauchlichen manualmedizinischen Techniken ein hohes Verletzungsrisiko fur die A. vertebralis. Diese werden entsprechend als obsolet fur die Behandlung von Sauglingen, Kindern und Adulten angesehen. Dem stehen nichtrisikobehaftete Techniken gegenuber. Zur Uberwachung des Sauglings bei der manualmedizinischen Behandlung wird die Polygraphie fur erforderlich gehalten.

The concept of position-dependent cerebral hypoxaemia as a mechanical cause of sudden death in infants is based on the possibility of flow impairment in the large neck vessels (carotid and vertebral arteries) on marked rotation and (or) flexion of head and neck. To test this hypothesis systematic flow measurements were performed post-mortem with 21 different angles of head and neck in 16 infants who had died suddenly. The angles chosen were those taken especially during sleep with the infant in a prone position. The measurements demonstrated flow impairment, especially as a result of mechanical narrowing of both vertebral arteries. On the other hand, the range of variation in the internal carotid artery was marked and individual circumstances could not be estimated. There was no certain connection between flow impairment in the vertebral artery and possible increase in the carotid artery. The least dangerous extreme movement for an infant is dorsal flexion of the neck with reclining of the head, a favoured position of many infants. Particularly dangerous is flexion combined with rotation. Judged by the number of complete flow stoppages in the vertebral and carotid arteries, the danger is greatest with rotation in dorsal flexion. Since the dangers of supine position have been known for a long time, lateral position is urgently recommended as the sleeping position in infants.

This paper deals with 301 families who have been offered a consultation for managing bereavement following sudden infant death. Eighty-eight percent of the parents (269 families) accepted and 36 more families out with Lower Saxony wished to be cared for. Without a previous autopsy 1.172 contacts happened from 1989 to 2003 comprising primary crisis intervention and long-term care, the latter including saying farewell before and after autopsy. One main aim was a close linking with the international self-help organization of parents (GEPS). Single cases conferences were carried out for more than five years according to the Sheffield model. There is given the methodical basis and many details of the care project.

A total of 58 cases of fatal trauma (forensic autopsies) were investigated for lesions of the pelvic girdle, the pubic symphysis, and for injuries distant from the pelvis. Traumata of the pubic symphysis were present in 30% (n = 17) of the cases. The symphyses were examined by x-ray and macroscopically related to the main violence (Abbreviated Injury Scale [AIS]). A correlation between the latter and the severity of the resulting injuries could be deducted. Characteristic patterns of symphyseal injuries included small hemorrhages, partial and complete ruptures, and also ruptures of the ligamentary insertions, which have not yet been described. The kind and severity of these lesions related to the intensity/direction of the violence are demonstrated and discussed.

PURPOSE: To compare digital X-ray, CT, and MRI in the evaluation of ligamentous and osseous lesions in upper cervical spine specimens after artificial craniocervical injury with the findings of macroscopic preparation. MATERIALS AND METHODS: A rotation trauma of defined severity was applied to 19 human corpses. After dissection of the neck specimens, digital X-ray (DIMA Soft P41, Feinfocus), conventional and helical CT (CTi, High Speed, GE, collimation 1 mm; pitch 1.0), and MRI were performed from the skull base to C3. The findings were correlated with the macroscopic results of preparation. MR (Magnetom Vision, Siemens) imaging was obtained with a 1.5 T system using 2D- and 3D-sequences. RESULTS: Preparation revealed 6 fractures of the vertebral bodies, 5 fractures of the dens axis, 1 fracture of the arcus anterior of the atlas, 4 osseous flakes at the occipital condylus, and 6 lesions of the alar ligaments. Digital radiography showed all fractures and 4 osseous flakes at the occipital condylus. With conventional and helical CT, all fractures and all ruptured alar ligaments could be detected. 2D MRI depicted 9 of the fractures and 3D MRI showed fractures. With 2D MRI, 2 of the 4 osseous flakes at the condylus could be detected and with 3D MRI one occipital condylus fracture could be depicted. Ligamentous injuries were visualized by 2D MRI in 2 of 6 cases and by 3D MRI in one case. CONCLUSIONS: In post-mortem studies, CT was superior to MRI in the visualization of osseous and ligamentous injuries after trauma of the upper cervical spine. However, these results are not transferable to patients with rotation injury in general.

Trauer und depressive Syndrome gehoren zu den normalen Reaktionen von Eltern nach einem Plotzlichen Kindestod („sudden infant death”, SID). Wir berichten im folgenden aus psychiatrischer und rechtsmedizinischer Sicht uber 2 Falle, in denen die Mutter nach SID mit ausergewohnlich schweren Depressionen reagierten und sich selbst vorwarfen, sie hatten ihr Kind getotet. Abschliesend werden einige Empfehlungen fur die Betreuung betroffener Eltern mitgeteilt.

Alterations in the heart rate were monitored before, during and after the application of a unilateral mechanical impulse to the high cervical spinal cord region which was administered strictly in connection with the so called manual therapy (diagnosis= KISS). The investigation is based on a survey of 695 infants between the ages of 1 and 12 months. A notable change in the heart rate was evident in 47.2% of all examined infants (n= 695). In 40.1% of these infants, the change in heart rate was characterized by heart rate decrease of 15-83% compared to control conditions. Infants in their first 3 months of life responded more often with a severe bradycardia (50-83% decrease), older infants (7-12 months) more often with a mild bradycardia (15-49.9% decrease). This comparison revealed a significantly increased occurrence of severe bradycardia in the younger age group compared to the group of children >3 months (significance 0.0017). In 12.1% (n= 84) of the infants, the bradycardia was accompanied by an apnea. We discuss the hypothesis that mechanical irritation of the high-cervical region serves as a trigger that may be involved in sudden infant death (SID).

The aim of this study was to investigate vegetative reactions in infants after mechanical irritation of the suboccipital region. The investigation is based on 199 infants who were observed while being treated with a suboccipital impulse (manual therapy). The results revealed vegetative reactions in more than half of all cases (52.8%, n = 105). The frequency of such vegetative reactions observed was at follows: flush 48.7% (n = 97), apnoea 22.1% (n = 44), hyperextension 13% (n = 26), and sweating 7.5% (n = 15). It is pointed out that approximately 25% of all the infants examined reacted by apnoea due to a mechanical irritation of the suboccipital region. This symptom was part of an extensive vegetative reaction. This method of inducing an apnoea has not yet been described; from this it follows that there are close relations to sudden infant death.

Injuries following autoaggressive behaviour are found in patients examined in forensic medicine as well as in psychiatric clinics. Self-mutilation often is combined with a borderline personality disorder in psychiatric patients. Our investigation compares injuries and wounds in psychiatric patients and those in persons examined in the Institute for Forensic Medicine after referral by the police. Our intention was to show evident differences and/or conformities in both of these groups. Additionally we describe a 'third group' of patients which has not yet been mentioned. These women showed, at the same time, characteristics of patients with overt self-injuries and of those with non-overt self-injuries. In this 'third group' we can often find a mixture of reality and fantasy/imagination.

Most cases of disputed paternity can be adequately resolved by testing the conventional blood group, serum and enzyme systems, perhaps completed by testing the HLA system. The analysis of DNA polymorphisms is a very useful additional system for distinguishing falsly accused non-fathers from “true” fathers and for providing convincing evidence in favour of paternity in cases of non-exclusions. The purpose of this presentation is to report the results from some extraordinary paternity cases in which the analysis of DNA polymorphisms greatly helped clear up the paternity.

Ein Vergleich der Phospholipidkonzentration im Serum von Herz- und Sinusblut mit dem Hamolysegrad dieser Blutproben, dem Lebensalter, Geschlecht, Arteriosklerosegrad und der Todesursache bei 145 unselektierten Leichen, die nicht faulnisverandert waren, ergab trotz breiter Streuung der Einzelwerte eine Abhangigkeit von der Todesursache, nicht jedoch von Alter, Geschlecht und dem Arteriosklerosegrad. Wahrend mit geringeren Stufen der Hamolyse eine Abnahme der Phospholipidkonzentration einherging, deutete sich bei ausgepragter Ha molyse eine Zunahme an. Die Analyse der Ergebnisse von 46 Todesfallen durch Erhangen erbrachte eine Bestatigung der grundlegenden Untersuchungen von Berg, wonach vermehrt Phospholipide in Sinne einer vitalen Reaktion wahrend des Strangulationsvorganges ausgeschuttet werden. Als Folge der Halsgefaskompresion ergaben sich dabei statistisch gesicherte Unterschiede in der Phospholipidkonzentration im Serum von Herz- und Sinusblut.

In the archives of the accident hospitals available, the data of patients who had been hospitalized because of a penetrating or blunt abdominal trauma in the last two years before the surveys were evaluated. Besides the abdominal trauma, at most trivial injuries of other regions were permitted. The data which might give information on how massive the intraabdominal injury was and/or the severity of shock symptoms were taken from the patient record sheets. Afterwards, it was attempted to obtain in an interview details on the external circumstances, the course of the accident event itself and the nature of the reaction to the trauma. Finally, 32 casualties (14 with penetrating and 18 with blunt abdominal injury) were surveyed. Fundamental differences in the behavior of these two subgroups were detected and verified with statistical test techniques. Circumspect behavior after penetrating abdominal trauma was characteristic. Nevertheless, in a few cases there was loss of the ability to act even in limited penetrating injury of the abdominal wall. However, the casualties themselves had the impression of a severe stab injury and this determined the primary reaction to the trauma. A fundamentally different behavior pattern was shown by those who had suffered a blunt abdominal injury. For them, it was typical that they became unable to act immediately or within a few seconds. With regard to the significance of pain, the restriction of motor movements as well as the relation of assumed and clinically verified injury severity is dealt with in respect of the capacity to act in a comparison of the two subgroups.

In order to prove the diagnostic value of cervical discography, a postmortem investigation was carried out on 70 trauma fatalities and 30 atraumatic fatalities of comparable age distribution. It was shown that, depending on the functional state of the intervertebral disk, the contrast medium flowed from the central depot into the "degenerative" cleft systems, from there frequently in front of the posterior longitudinal ligament into the uncovertebral joints and from there into the epidural space even in injured movement segments. On the other hand, despite the large number of false positive results only a relatively small percentage of the injuries was investigated. Discography would be a specific diagnostic method merely for central intervertebral disk disruption. However, this injury type is a rare special form.

The intradural sagittal diameter at the second cervical vertebra (SD/C2) of 62 SIDS cases was measured myelographically. This SD/C2 proved to be dependent on body size, body weight, and age. A clear, age-dependent difference is to be found in the primarily narrow spinal canal. This parameter (SD/C2), which is more precisely defined in adults on the basis of clinical, radiological, and autopsical findings is assumed to have the value of 0.5 cm in the first 2 months, 0.6 cm in the third month, and 0.65 cm in the fourth month. The resulting potential danger to infants is dependent upon their position. The SD/C2, was significantly decreased in extension as compared to a neutral posture. With consideration of the primarily narrow spinal canal in the infant, there is, according to our measurements, a potential hazard for the infant in any further, significant shortening of the SD/C2. This is independent of the width of the spinal canal under maximal extension. We found individual cases in which the SD/C2 was decreased by almost 50% from the normal value in neutral position. No correlation was found between the primary width of the spinal canal and the degree of luminal reduction upon extension.

Radiological and patho-anatomical investigations of the spines of 32 corpses of persons who had committed suicide by hanging revealed spine damage in 81% of the cases. The cervical spine was damaged in 69%, the lumbar spine in 56% of the cases. The typical damage of the cervical spine is a loosening of the discs at the dorsal side, usually at the level of C 4/5 to C 6/7. In the region of the lumbar spine, bleeding between the (anterior) ventral ligament and the discs is the most frequently observed damage (Simon's sy;mtpom). Simon bleeding is brought about by traction force and is not dependent on the age at death or on any existing degenerative changes of the spine.

Nach einer Definition des Begriffs Schleudertrauma wird der Anteil derartiger Verletzungen anhand 334 unausgewahlter todlich Traumatisierter in einem gerichtsmedizinischen Obduktionsgut mit 12% angegeben. Verletzungen des Halses fanden sich in diesem Kollektiv in 76%, nur die Halswirbelsaule betreffende in 68%. Allein in 20% waren diese indirekten Verletzungen der HWS als Todesursache anzusehen.

Untersuchungen an 504 menschlichen Zungenbeinen haben ergeben, das drei Grundformen existieren, deren Auftreten in bestimmtem Mase geschlechtsspezifisch ist. Die Junktur zwischen dem Korper und den grosen Hornern des Zungenbeins ist haufig auch noch im fortgeschrittenen Alter nicht knochern. Eine Altersbestimmung anhand der Verbindung Corpus-Cornu majus ist von daher als auserst unzuverlassig anzusehen.

In comparison to the pattern of lesions of the soft tissue of the neck and the CVC in case of suicidal hanging 17 postmortal fracture-dislocations of the neck are investigated. It could be demonstrated that on principle in case of hanging the dens-fracture can occur. With respect to the hangman's fracture (Wood-Jones) a differentiation into 3 types is proposed.

Auf Grund exakter Ausmessungen an kaltefixierten Halswirbelsaulen von Unfall-Leichen und an standardisierten Myelographien lies sich ein Quotient aus Spinalkanaldurchmesser und Ruckenmarksbreite ermitteln, der als rechnerischer Wert diese Raumverhaltnisse charakterisiert.

An 168 Praparaten menschlicher unterer Hohlvenen wurde die Gesamtheit der elastischen und plastischen Krafte bestimmt.

Den Frakturen der Condyli occipitales ist, anders als dem grosen Bruchsystem der Schadelbasis, bisher nur wenig Aufmerksamkeit gewidmet worden. Dabei wurde in zumeist kasuistischer Form auf die Bruchmechanik eingegangen. Mit der vorliegenden Untersuchung wird, gestutzt auf das Schrifttum und das eigene Material, der Versuch einer Klassifizierung unternommen. Condylus-Frakturen im Sinne von Aussprengungen oder durchsetzender Verletzung werden folgenden Beanspruchungsformen zugeordnet: 1. Axiale Kompression (Jefferson-Typ) Condylusimprimierung 2. Axiale Traktion (Hangman's-Typ) Condylusausris 3. Rotation mit axialer Beanspruchung Condylusausris 4. Schrag-Kompression (Berstungsfraktur des Widerlagers) Condylus-Frontalfraktur; contralateral 5. Schrag-Traktion (Horizontalschub) Schadelbasisabris als contralaterale Condylus-Horizontalfraktur 6. Querschub (Schadelbasislangsfraktur) Condylus-Partialausris

Um den unter extremen Bedingungen tatigen Notarzten eine Ruckmeldung uber das Ergebnis ihrer Bemuhungen liefern zu konnen, wurden in einer Basisuntersuchung die Komplikationen von Reanimationsmasnahmen bei 30 atraumatischen Todesfallen, bei denen auch ein finaler Sturz auszuschliesen war, analysiert. Danach bestehen zwei Pradilektionsstellen fur Verletzungen, namlich Thorax und Hals.

In einer prospektiven Untersuchung fanden sich bei 204 unausgewahlten Fallen suicidalen Erhangens in 51% Stauungsblutungen verschiedener Schweregrade. Sie bestanden beim typischen symmetrischen Erhangen (n=38) in 42%, beim atypischen (n=152) in 53%. Der Unterschied war nicht signifikant. Zwischen den auseren Stauungsblutungen einschlieslich denen in den Halsweichteilen einerseits und der Hangform, der Schlingenfuhrung sowie der Breite des Strangwerkzeuges konnten statistisch keine Zusammenhange gesichert werden. Eine nur geringe Abhangigkeit ergab sich lediglich vom Alkoholgehalt des Blutes. Das Hirngewicht der Erhangten lag in allen Altersklassen uber dem eines klinischen Vergleichskollektivs. Es zeigte ebenfalls keinen Zusammenhang mit der Auspragung der auseren Stauungszeichen.

The vertebral artery was investigated in suicidal hanging for specific forensic, but also general traumatological reasons. The objective was to establish the extent to which the vertebral artery in its relatively protected position is injured at all and if so, in what form. For this purpose, cervical spine preparations with the posterior space of the skull were fixed in formalin and detached in the sagittal plane in 36 unselected cases of suicidal hanging after angiographic visualization of the vertebral artery. Afterwards, both vertebral arteries were visualized, and vascular injuries were compared with injuries of the soft tissues of the neck, of the cervical spine, and of the external types of hanging. The vertebral artery was shown to be injured quite frequently (rupture, intimal tear, sub-intimal hemorrhage), namely in one quarter of all cases, and indeed in more than half taking into account the perivascular bleeding. In this way, frequencies were found which were far in excess of those of the common carotid artery. The different mechanical behavior of these two paired neck arteries in traction are dealt with and the form of injury explained.

The odontoid process of the axis is the most peculiar structure of the upper cervical spine. It is the center of the median atlantoaxial joint, which functions as a pivot articulation. The annular articulation, formed by the anterior arch and the transverse ligament of the atlas, is apposed to the anterior and posterior surfaces of the odontoid. The axis of the odontoid process does not generally coincide with that of the body of the second cervical vertebra in adults. Depending on the very individual curve of the cervical column, the odontoid might be straight or inclined dorsally or ventrally (5, 6 ). The purpose of this paper is to analyze the nature of distortion in the odontoid. This includes measurement and comparison of its degree of inclination both in young children and in adults. X-rays of median-sagittal sections of the odontoid which were made for the study of trabecular structure in adults were functionally interpreted on the basis of density distribution and architecture with respect to the degree of odontoid angulation.

Trotz vielfaltiger Bemuhungen war bisher weder fur die Diagnostik, die Therapie noch fur die Begutachtung eine einheitliche Verwendung des Begriffs „Schleudertrauma“ (Whiplash injury) durchzusetzen.

Two cases of death have been reported following a wasp sting. In both cases an anaphylactic reaction after sensitization can be assumed (positive RAST result). In one case an expert witness report was required because of questions concerning insurance law (accident at work?) in addition to the cause of death. The stinger of the wasp was examined from the zoological aspect and is compared with that of the honeybee and hornet.