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After the death of a 63-year-old woman following pressure against the neck, the injury was assessed forensically and a radiological-preparatory examination of the osseous structure of the larynx was conducted. We used fine preparation and, for further characterization of the fracture, radiological imaging in spiral CT, 3D reconstruction and fine-focus technique (mammography). While a skeletal injury with the basal fractures of the upper horns of the thyroid cartilage was clearly visible in the CT and 3D reconstruction, the radiological visualization of a 3-4mm wide wall-penetrating dehiscence in the upper part of the thyroid cartilage commissure required a higher sensitivity. Using fine-focus technology, we were able to diagnose this fracture as an avulsion of the cartilage from the medial primary ossification center of the thyroid cartilage. Not only has this type of fracture of an insertion avulsion of the median thyrohyoid ligament never been described before, but it must also be considered as the main fracture in dorsocranial traction. In this specific case, it enabled the expert to state in court that strangulation had occurred from behind.

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.

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).

Every subsequent pregnancy after the loss of a child due to Sudden Infant Death (SID) causes highly anxious parents. The aim of this investigation was to point out which feelings and experiences have to be considered as influencing factors for a following pregnancy--besides being afraid of a repeated loss. The overlapping fixing of our aim was to develop some proposals and recommendations for a capable accompanying during a subsequent pregnancy.The base of the evaluation were 789 consultations during long-term cares of 115 families affected by Sudden Infant Death (SID). When their children died because of SID 9 of all the mothers were pregnant again. In the families which were cared for half-a-year or longer (n = 80), 47 (58.7%) subsequent pregnancies became known. All gravidities occurred within one year after SID except two cases.We found a strong exigency for information, structure and protection during the whole pregnancy. This fact can be deducted from a high potential of anxiety and fear within the parents. Furthermore, our investigation revealed considerable doubts of the mothers about their parental competence and altered, but still intensive affects of grief yet confidence and great joy as well. Besides, we also observed problematic social experiences, as e.g. hushing up of the dead child or a lacking acceptance of grief by the social environment.A supporting and reliefing accompanying during a subsequent pregnancy comprises a continuous enlightenment of parents by being honest and open even in giving unpleasant and burdensome informations. It is recommended to show understanding for the exceeding anxieties of the parents, to offer them more possibilities of examinations and conversations as usually appropriate and to talk to them about their dead child and grief. Often the arrangement of contact to a parent-self-help association is the essential offer of support.

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.

We used beta-amyloid precursor protein (beta-APP) to investigate our own forensic neuropathological case material (n = 252) in light of the current literature on the phenomenon "axonal injury" (AI) to determine the incidence, specificity and biomechanical significance of AI and its significance for determining vitality and survival time. The case material consisted of cases of fatal nonmissile closed-head injury (n = 119), gunshot injury (n = 30), fatal cerebral ischemia/hypoxia (n = 51), brain death caused by mechanical trauma (n = 14) or nonmechanical injury (n = 18), and acute hemorrhagic shock (n = 20). AI was observed in 65% to 100% of cases of closed-head injury, fatal cerebral ischemia/hypoxia, and brain death with a survival time of more than 3 h; AI could not be detected in the cases of acute hemorrhagic shock. A statistically significant difference between traumatically and nontraumatically induced (nondisruptive) AI was not found. There was no statistical evidence of a correlation between AI and the different types of external force, since AI could be demonstrated after both acceleration/deceleration injuries and traumatic impact. Therefore, biomechanical inferences for reconstruction purposes are not possible. On the other hand, beta-APP was found to be a definite marker of vitality. In our material, cases with a posttraumatic interval of under 180 min did not express beta-APP. Moreover, the literature shows that the posttraumatic interval can be determined by other methods for demonstration of AI such as by ubiquitin immunostaining (360 min), silver staining (15-18 h), hematoxylin and eosin staining (about 24 h), or by demonstration of a microglial reaction (about 4 to 10 days) or of a few remaining isolated bulbs, without accompanying fibers, which can be detected after a survival time of up to 17 months.

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.

The phenotypes of 56 families with 126 children from the Hamburg area as well as gene frequencies and segregation of the genetic markers GPT, AP, ADA, AK, PGM1, PGM3, 6-PGD, CHE, C3, Gc, Tf, Hp and Cp were studied. In regard to linkage, the informative families were correlated to the results of HL-A and GPT typing. The linkage was tested according to the sequential test by Morton (1955). At the recombination fraction Θ = 0.05, independence could be observed for HL-A/AP, HL-A/ADA, HL-A/PGM1, HL-A/C3; HL-A/Gc, HL-A/Hp and GPT/AP. In the range of Θ = 0.1, for HL-A/PGM1, HL-A/Gc and HL-A/Hp independence was stated. The linkage HL-A/PGM3, reported first by Lamm et al. (1971), could be confirmed. For other gene loci, linkage to the HL-A or GPT system could not be proved. But the positive lod scores of HL-A/GPT, HL-A/AP and GPT/6-PGD may give indication for linkage.

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.

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.

A comparison of phospholipid content of sera from heart blood and sinus blood from the brain with the rate of haemolysis in the blood samples, with age, sex, degree of arteriosclerosis and cause of death, showed a relationship with the cause of death in spite of wide dispersion of the single values. The remaining factors of the 145 unselected human cadavers, which were not putrefied, seemed to have no influence. Small amounts of haemolysis caused a decrease of phospholipid concentration whereas an extensive haemolysis clearly led to an increase. The results of 46 deaths by hanging confirmed the fundamental studies of Berg (1950, 1952), who demonstrated that an increased secretion of phospholipids during the strangulation process is to be interpreted as a vital phenomenon. Compression of cervical vessels resulted in statistically significant differences between phospholipid concentrations in serum of heart and sinus blood.

The hangman's fracture is since Wood-Jones (1913) considered to be a pedicle fracture of the axial arch, combined with extensive lacerations of the intervertebral disk and the longitudinal ligaments in spine motion segment C2/3. In its mechanics it is ascribed to a non-physiological strain in the sagittal plane in particular due to added submental pressure. The various forms of strain which cause the phenomenon of the hangman's fracture are discussed in detail. In this context it appears that for the model conception chosen one must invariably also consider a rotary component. The definition of the pedicle fracture requires profound reexamination, since this topographic region manifests itself only from C3 onwards but not in the area of the axial arch. After the consideration of the location of the fracture plane the proposition is made to comply with clinical considerations instead and to define it as an intraarticular or extraarticular arch fracture. In the conclusion it is demonstrated in an exemplary manner that the monosegmental injury of the intervertebral disk and the longitudinal ligaments in the segment C2/3 considered to be typical need not be mandatory. However, if it is not present, injuries in the soft-tissue of the lower motion segments are to be expected.

Investigations on 504 human hyoid bones show that there exist three main types, whose occurrence is, to a certain degree, sex-related. The junction between the body and the larger horns of the hyoid often is not ossified even in advanced age. Any determination of age on the basis of the extent of the corpus-cornu maius-ossification is most unreliable.

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 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.

In a prospective study of 204 unselected cases of suicidal hanging congestion bleedings of different degrees were found in 51%. In typical symmetrical hanging (n = 38) they occurred in 42% of cases, in atypical suspension (n = 152) in 53%. The difference had no statistical significance. Statistically, no connection could be secured between the outer congestion bleedings including those within the neck soft tissue on the one hand, and the form of hanging, the kind of loop or the breadth of the strangulation tool on the other. Only a slight dependence on the blood alcohol content was established. The brain weight of the hanged cases was higher in all age groups than in a clinical autopsy collective. Likewise, it showed statistically no relation to the degree of the outer congestion signs. In 36 cases the brain was histologically investigated. In 78% of cases hyperemia was found, concerning predominantly the supply tract of venules, but also the capillary part. It existed both in typical and in atypical hanging. Independent of outer congestion signs and of cerebral hyperemia, small bleedings into the cerebral perivascular space could be observed in 50% of cases. The increase in brain weight in association with histological signs of edema in hanging was put down to a definite terminal-postmortal brain swelling, as it is known in all forms of peracute death. There is no connection with the type of suspension and the existence or non-existence of congestion signs. Also in atypical forms of hanging no reference to a cerebral residual perfusion is given.

The status of the large vessels of the neck was determined after emergency intubation in 65 primary atraumatic casualties in the endeavor to provide accident surgeons working under extreme conditions with a check on results to optimize their therapy. Besides the findings in the vertebral artery (shown in 35 cases), which was traumatized in one case, the main attention was dedicated to the injury pattern of the common carotid artery. In this artery, intimal ruptures within the bifurcation were found in three cases, combined in one case with a subintimal hemorrhage on the contralateral side. As compared to other forms of force leading to an injury of the common carotid artery, reanimation causing traction and hyperextension of the neck is also considered an injurious stress. The unconscious patient is especially endangered as he has no possibility of pain-elicited defense if a helper hyperextends the neck under pressure from below in the vertex of the lordosis.

The investigation was carried out on 11 sudden infant death (SIDS) cases which were compared with age- and sex-matched controls. Six brain nuclei were selected for evaluation. Using immunohistochemical methods, macrophages were selectively demonstrated by detection of lysozyme; reactive astrocytes, by detection of intracytoplasmic albumin (marker of prior impairment of blood-brain barrier function) or GFAP. No lysozyme-positive cells were demonstrable in the brain stem of any of the examined cases. Although a greater number of reactive, GFAP-expressing astrocytes were found in the SIDS cases, 3 of the 11 SIDS cases (compared to 5 controls) had no reactive astrocytes in any of examined brain nuclei. Reactive astrocytes, however, were identified in more than half the controls. Sections treated with anti-albumin serum were evaluated quantitatively. Total number of non-neuronal cells, relative proportion of astrocytes, and proportion of albumin-positive astrocytes were determined. Paired brain nuclei were counted on both sides of the brain stem. The number of non-neuronal cells, astrocytes, and albumin-positive astrocytes in the SIDS cases did not differ significantly from those in the controls. No statistically relevant difference was established between the right and left parts of the brain stem. The findings were discussed in light of the literature.

The study was based on the hypothesis that cerebellar hypoxia may play a role in sudden infant death syndrome resulting in morphological changes of the cerebellar cortex, especially with respect to Purkinje cell density. In the morphological evaluation of the Purkinje cell layer, special consideration was additionally given to secondary alterations (i.e., macrophage and/or astrocyte reaction). A total of 12 sudden infant death syndrome cases were compared with an age- and sex-matched control group. The Purkinje cell density was evaluated by determining the number of these cells per surface unit on parasagittal sections in both hemispheres. The myelomonocytic and glial reaction was demonstrated by immunohistochemical methods using lysozyme as leukocyte and macrophage markers and glial fibrillary acidic protein as an astrocyte marker. Qualitatively, no alterations resembling a macrophage or glial cell reaction were detected in sudden infant death syndrome. No differences between the right and left cerebellar hemisphere could be established in the victims of sudden infant death syndrome nor in the controls. The number of Purkinje cells per 0.352 mm2 cortex was higher in the younger victims of sudden infant death (younger than 45 weeks of gestation) than in all matched controls. A statistically significant difference in Purkinje cell density, however, could not be established, and, especially, no indications of hypoxia were observed in the cerebellar cortex.

Reflections on the definition of the term "whiplash injury" are followed by comments on the mechanism of accidents. The author emphasizes the importance of the biphasic course of the trauma, involving a mass contraction, triggered by reflex action, of the initially suddenly overstretched muscle groups with their synergist. Reference is made to the ideas developed by Kummer, who considers the neck as an arcuate tendon construction with tractional tension on the dorsal as well as on the ventral side. In the analysis of the injury pattern of the cervical spine, the special forms of intervertebral disc injury are dealt with, the relationship to degenerative lesions prior to the accident and to secondary lesions (spondylosis deformans and osteochondrosis) are discussed in detail, and the consequences for writing medical expertises are mentioned.