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The aim of this study was to investigate if the biomarkers myelin basic protein (MBP) and neurofilament-H (NF-H) yielded informative value in forensic diagnostics when examining cadaveric cerebrospinal fluid (CSF) biochemically via an enzyme-linked immunosorbent assay (ELISA) and comparing the corresponding brain tissue in fatal traumatic brain injury (TBI) autopsy cases by immunocytochemistry versus immunohistochemistry. In 21 trauma and 19 control cases, CSF was collected semi-sterile after suboccipital puncture and brain specimens after preparation. The CSF MBP (p = 0.006) and NF-H (p = 0.0002) levels after TBI were significantly higher than those in cardiovascular controls. Immunohistochemical staining against MBP and against NF-H was performed on cortical and subcortical samples from also biochemically investigated cases (5 TBI cases/5 controls). Compared to the controls, the TBI cases showed a visually reduced staining reaction against MBP or repeatedly ruptured neurofilaments against NF-H. Immunocytochemical tests showed MBP-positive phagocytizing macrophages in CSF with a survival time of > 24 h. In addition, numerous TMEM119-positive microglia could be detected with different degrees of staining intensity in the CSF of trauma cases. As a result, we were able to document that elevated levels of MBP and NF-H in the CSF should be considered as usefulneuroinjurybiomarkers of traumatic brain injury.

The aim of the present study was a refined analysis of neuroinflammation including TMEM119 as a useful microglia-specific marker in forensic assessments of traumatic causes of death, e.g., traumatic brain injury (TBI). Human brain tissue samples were obtained from autopsies and divided into cases with lethal TBI (n = 25) and subdivided into three groups according to their trauma survival time and compared with an age-, gender-, and postmortem interval-matched cohort of sudden cardiovascular fatalities as controls (n = 23). Brain tissue samples next to cortex contusions and surrounding white matter as well as samples of the ipsilateral uninjured brain stem and cerebellum were collected and stained immunohistochemically with antibodies against TMEM119, CD206, and CCR2. We could document the highest number of TMEM119-positive cells in acute TBI death with highly significant differences to the control numbers. CCR2-positive monocytes showed a significantly higher cell count in the cortex samples of TBI cases than in the controls with an increasing number of immunopositive cells over time. The number of CD206-positive M2 microglial cells increased survival time-dependent. After 3 days of survival, the cell number increased significantly in all four regions investigated compared with controls. In sum, we validate a specific and robustly expressed as well as fast reacting microglia marker, TMEM119, which distinguishes microglia from resident and infiltrating macrophages and thus offers a great potential for the estimation of the minimum survival time after TBI. Electronic supplementary material The online version of this article (10.1007/s00414-020-02384-z) contains supplementary material, which is available to authorized users.

In the last few years, quantitative analysis of metabolites in body fluids using LC/MS has become an established method in laboratory medicine and toxicology. By preparing metabolite profiles in biological specimens, we are able to understand pathophysiological mechanisms at the biochemical and thus the functional level. An innovative investigative method, which has not yet been used widely in the forensic context, is to use the clinical application of metabolomics. In a metabolomic analysis of 41 samples of postmortem cerebrospinal fluid (CSF) samples divided into cohorts of four different causes of death, namely, cardiovascular fatalities, isoIated torso trauma, traumatic brain injury, and multi-organ failure, we were able to identify relevant differences in the metabolite profile between these individual groups. According to this preliminary assessment, we assume that information on biochemical processes is not gained by differences in the concentration of individual metabolites in CSF, but by a combination of differently distributed metabolites forming the perspective of a new generation of biomarkers for diagnosing (fatal) TBI and associated neuropathological changes in the CNS using CSF samples.

Background Human hippocampal area Cornu Ammonis (CA) 1 is one of the first fields in the human telencephalon showing Alzheimer disease (AD)-specific neuropathological changes. In contrast, CA2 and CA3 are far later affected pointing to functional differences, which may be accompanied by differences in proteome endowment and changes. Methods Human pyramidal cell layers of hippocampal areas CA1, CA2, and CA3 from neurologically unaffected individuals were excised using laser microdissection. The proteome of each individual sample was analyzed and differentially abundant proteins were validated by immuno-histochemistry. Results Comparison of CA1 to CA2 revealed 223, CA1 to CA3 197 proteins with differential abundance, among them we found motor proteins MYO5A and DYNC1H1. Extension of the study to human hippocampus slices from AD patients revealed extensive depletion of these proteins in CA1 area compared to unaffected controls. Conclusion High abundance of motor proteins in pyramidal cell layers CA1 compared to CA2 and CA3 points the specific vulnerability of this hippocampal area to transport-associated changes based on microtubule dysfunction and destabilization in AD.

The concept of spontaneous combustion has huge appeal as an historical fiction but it has no scientific background. However, in some deaths involving fire, a body can burn away virtually completely with minimal thermal destruction to the neighboring environment. We report an extraordinary case of the self-immolation of an elderly woman who set herself on fire with suicidal intentions. The unusual appearance and location of the body closely resembled the phenomenon of so-called spontaneous human combustion because the upper parts of the body were almost totally destroyed by fire, while the legs and surrounding structures remained almost untouched by flames. The results of all investigations proved that the woman set fire to her body using a box of matches and accelerants (concentrated ethanol and a solid firelighter). Near-total combustion of her body subsequently occurred during the postmortem period. The development of alleged spontaneous human combustion requires the following: ignition (external heat source), fuel (molten human fat), a wick (e.g. charred and porous clothing, bedding, or ground), time, and an optimal microclimate for gradual burning.

Crania are a reliable source for sex estimation in Euro-Americans, Europeans, and most other populations. Besides morphological assessments, the application of Fordisc® has become a useful tool within the last two decades, creating discriminant functions from morphometric data. Unfortunately, until now, white populations are mostly represented by measurements of American individuals. Therefore, classification rates are lower for European skulls than for Euro-Americans. The aim of this study was to show differences in sexual dimorphism between German and Euro-American crania. Furthermore, their secular change from the nineteenth to the twentieth century has been investigated. Analyses have been performed on glabella subtense (GLS), mastoid height (MDH), and bizygomatic breadth (ZYB). Fordisc® 3.1 was used to study sexual dimorphism and secular change, whereas SAS® was used to perform a two-level ANOVA to test for variation in sex dimorphism. Euro-Americans show greater dimorphism than Germans in all three measurements tested. This larger difference is even increasing from the late nineteenth through the late twentieth century in terms of GLS and MDH, while it stays almost the same in the present Europeans. These results explain the unsatisfying classification rates of German and other European crania on Fordisc®. Data collection for European Fordisc® samples is in progress and should improve the current situation.

Whenever blunt or sharp forces are used in a crime, analysis of bloodstain pattern distribution may provide important information for the reconstruction of happenings. Thereby, attention should be paid to both the crime scene and the clothes of everyone involved in the crime. On dark textiles, though, it is difficult or even impossible for the human eye to detect bloodstains because of the low contrast to the background. However, in the near infrared wavelength range, contrast is considerably higher. Many textiles reflect light beyond a wavelength of 830 nm and thus appear light-colored, whereas blood absorbs the light and appears dark. In our studies, a D7000 NIKON reflex camera modified for infrared photography produced high-resolution photographs visualizing even very small spatter stains on dark textiles. The equipment can be used at any crime scene or lab and provides immediately available and interpretable images. Thus, important findings can be obtained at an early stage of police investigations, as two examples (homicide and attempted homicide) illustrate.

To find out the time since death (PMI) of a human individual, from which only skeletal remains are left is a difficult question to answer, since methods currently available don’t bring concrete answers. Subsequent to our validation study on porcine bones, we focused on human bones analysing if collagen degradation would occur at a predictive rate so that the method may be used for PMI-estimation. We tried to reproduce a method for determining the Co/NCo (Collagen to Non-Collagen) ratio of porcine bones Boaks et al. demonstrated in 2014. Our study sample consisted of 37 human bones from a forensic PMI context and 11 archaeological samples; we prepared thin bone sections of 250 µm; after staining the sections we used spectrophotometry for a portion of the samples and stereomicroscopy and digital imaging to analyze the Co/NCo ratio. Detecting the Co/NCo ratio with spectrophotometry produced results much lower than those published by Boaks et al. (2014) on porcine bone samples and much lower than physiologically expected; a similar result we also got in our validation study on porcine bone samples. We, therefore, applied our new method of stereomicroscopy and digital imaging, which we previously tested on porcine bones. The samples of male individuals showed a significant reduction of the Co/NCo ratio correlating to the PMI. Nevertheless, we still consider analyzing the Co/NCo ration of human bone samples not sufficient for forensic issues. Therefore, greater reference data as well as more experience in practice are needed.

A 31-year-old female asthmatic patient received an infusion of metamizole and tramadol for chronic pain at a GP surgery. After a few minutes, the patient developed breaing difficulties and died in spite of resuscitation measures. The general practitioner was suspected of medical malpractice. Medico-legal investigations confirmed the assumption that death was caused by anaphylacitic shock. In spite of temporary intubation into the oesophagus no evidence of medical malpractice was found, however.

Protrusion of the tongue is a common, though often neglected finding in fire fatalities. According to a study recently published by Bernitz et al., it is an indicator of vital burning. This statement has been doubted repeatedly. Retrospective analysis of 61 fire fatalities from our own autopsy material did not show any statistically significant increased incidence of tongue protrusion in deaths with vital exposure to heat. Similarly, there was no correlation with the degree of destruction by the fire in general or the extent of cervical burning. Further prospective studies seem to be necessary also with regard to the pathophysiological processes.

In the present study, a series of reflectance spectra of postmortem lividity, pallor, and putrefaction-affected skin for 195 investigated cases in the course of cooling down the corpse has been collected. The reflectance spectrometric measurements were stored together with their respective metadata in a MySQL database. The latter has been managed via a scientific information repository. We propose similarity measures and a criterion of similarity that capture similar spectra recorded at corpse skin. We systematically clustered reflectance spectra from the database as well as their metadata, such as case number, age, sex, skin temperature, duration of cooling, and postmortem time, with respect to the given criterion of similarity. Altogether, more than 500 reflectance spectra have been pairwisely compared. The measures that have been used to compare a pair of reflectance curve samples include the Euclidean distance between curves and the Euclidean distance between derivatives of the functions represented by the reflectance curves at the same wavelengths in the spectral range of visible light between 380 and 750 nm. For each case, using the recorded reflectance curves and the similarity criterion, the postmortem time interval during which a characteristic change in the shape of reflectance spectrum takes place is estimated. The latter is carried out via a software package composed of Java, Python, and MatLab scripts that query the MySQL database. We show that in legal medicine, matching and clustering of reflectance curves obtained by means of reflectance spectrometry with respect to a given criterion of similarity can be used to estimate the postmortem interval.

A 23-year-old woman was mortally afraid of dental interventions and decided to have her four wisdom teeth removed by outpatient surgery under endotracheal anaesthesia. According to the files, the patient was categorized as ASA I and Mallampati II, and surgery was considered an elective routine intervention. Soon after initiation of anaesthesia, O2 saturation and blood pressure dropped, and the young woman died shortly afterwards in spite of immediate resuscitation measures. At first, an allergic reaction to succinylcholine, which had been administered as a muscle relaxant, was suspected. Autopsy and histological examination showed haemorrhagic pulmonary oedema and a defined lesion in the midportion of the oesophageal mucosa in spite of correct placement of the endotracheal breathing tube. Ultimately, misintubation into the oesophagus, which had not been noticed at first, was determined as cause of death.

As to their optical properties, the components of human skin can be divided into two different categories: the light-scattering components shown as peaks and those absorbing light appearing as dips in the reflectance spectrum. As the post-mortem interval progresses, the concentration of scatterers and absorbers and thus the reflectance spectra change due to post-mortem tissue breakdown and degradation. Based on a total number of 532 reflectance spectrometric measurements in 195 deceased, a characteristic change in the reflectance spectra could be documented in the post-mortem course. Subsequently, an algorithm to calculate the post-mortem interval was developed by analysing the reflectance spectrometric extrema.

Immunohistochemical studies about the presence of fibronectin in the lungs were performed in a group of 73 fire victims (63 cases of intravital and 10 cases of postmortem burn) as well as in an unselected control group of 55 individuals not exposed to fire before death. The cases of intravital burn showed a significantly stronger fibronectin expression than the control cases and the cases of postmortem burn. Fibronectin was mainly present in macrophages of the peribronchial lung parenchyma and, not associated with cells, in the matrix of peribronchial tissue. Our findings suggest that higher levels of fibronectin expression in the lung tissue of burn victims compared to fire-unrelated deaths may serve as an indicator of an early intravital inflammatory response to fire damage.

A 23-year-old woman traveling in the front passenger seat of a car was killed in a traffic accident involving two rear-end collisions. After the second rear-end collision, the car caught fire. While the driver could be rescued, the pregnant passenger remained inside the car. After the fire had been extinguished, a charred body was found in a pugilistic attitude with an exposed abdominal cavity and a ruptured anterior wall of the gravid uterus. Between the woman's legs, an almost unburned fetus was found with body measurements corresponding to a gestational age of 28 weeks. The placenta had remained inside the uterine cavity and was still connected with the fetus via the umbilical cord. In conclusion, the rupture of the pregnant uterus with expulsion of the fetus had to be considered a secondary event due to the initial heating and subsequent shrinking of the uterine wall.

During the autopsy of fire victims, one often sees intensive reddening of the inner vascular layers resembling changes due to putrefaction. To determine the frequency of this phenomenon and the circumstances under which it occurs, in particular the presence of putrescence, signs of vitality and the extent of destruction by the fire, the fire fatalities autopsied at the Institutes of Legal Medicine in Freiburg, Halle and Würzburg were analyzed. In the concrete study, 259 fire deaths were investigated retrospectively and 21 prospectively. The study material included 191 males and 68 females aged 0 to 93 years. Vital exposure to the fire was found in 70%, perimortal exposure in 23 % and postmortem exposure in 7% of the cases. Red discoloration of the intima of the central vessels was seen in 106 victims (41%). This finding is most likely caused by postmortem heat-induced hemolysis, which occurs when the temperature in the body rises above 52 °C due to the effect of external heat. Therefore, a reddish discoloration of the intima cannot be regarded as sign of vitality.

In terms of physics, the skin can be regarded as an optically turbid medium in which the light is mainly scattered by the collagen fibers, mitochondria and cell nuclei, whereas the absorption is determined by the content of reduced hemoglobin, oxyhemoglobin, bilirubin, and melanin. When the measuring geometry and the illumination spectrum are known, the optical characteristics of the skin can be approximately described by the diffusion and absorption coefficients. These values define the diffusion and absorption probability per unit distance traveled for each wavelength. Based on these parameters, a mathematical skin model was developed with the help of Monte Carlo simulations. By implementing the absorption coefficient of carbon monoxide hemoglobin (CO-Hb) into the skin model, the authors wanted to investigate whether this method is suitable to determine the CO-Hb concentration from spectral reflectance curves of livores. The investigations performed on 28 deaths from CO poisoning so far showed that this is generally possible. In almost all cases, the actual CO-Hb values could be estimated correctly by using the Monte Carlo simulations.

The most important signs of vitality in burned bodies are soot deposits in the respiratory tract, the esophagus and the stomach as well as elevated CO-Hb values in the blood. But these findings show only that a person was exposed to fire fumes while alive; they are no indicator for vital heat exposure. As the external findings in burned bodies are often not very conclusive due to postmortem consumption by the fire, the internal findings are all the more important. Macroscopic signs that hot fumes were inhaled may be edematous swelling and vesicular detachment of the mucosa in the pharynx, the larynx and/or the upper section of the esophagus. As histological changes in the respiratory tract soot deposits, vesicular detachment of the epithelium, hyperemia and edema of the tracheal and bronchial mucosa as well as increased secretion of mucus have been described. These findings may partly be absent although the victim was alive during the fire, which can make diagnosis more difficult. Especially in peracute deaths vitality findings are usually sparse. The significance of the macroscopic and histological parameters of vitality was systematically investigated on the basis of our own autopsy material from the years 1996-2002 (88 cases) and compared with the statements found in the literature. In our study material, the vitality parameters were incomplete in 23% of the burned corpses. In 3% of the cases the question whether there was an antemortem heat exposure could not be answered.

When inspecting the scene the circumstances under which a body is found and the findings on the body surface may give first clues to premortal drug abuse. Besides fresh and/or old injection marks tattoos, underweight and signs of physical neglect, especially after long-term abuse, are mentioned in literature. The incidence of such externally visible physical signs of drug abuse was systematically investigated in 100 consecutive drug deaths occurring from 1995 to 1997. Sixty-eight percent of the bodies were found in the apartments of the deceased or those of friends, 11% in public restrooms or the washrooms of restaurants. The so-called body dumping was seen in three cases. In 61% externally visible, fresh injection marks were found; on dissection of the subcutaneous veins, residues of previous injections were found in 95% of the cases. Tattoos were present in 63%. In 8% there was clear evidence of physical neglect. Eighty-six percent of the drug victims had a normal nutritional status.

In hanging and ligature strangulation, the noose mostly causes a mark or groove which is formed partly by compression of the skin and partly by abrasion with loss of the upper epidermal layers. The horny scales abraded from the neck may be transferred to the strangulation device or to the interposed textiles where they are sometimes visible at stereomicroscopic examination or even to the naked eye as silver-grey particles. The morphologic features of the epidermal transfer due to hanging and ligature strangulation is demonstrated by 14 case examples. The biological traces may be sufficient for comparative DNA typing by means of PCR-based methods. In 9 out of the 14 cases, genomic DNA typing was successful. Analysis of mtDNA succeeded in another two cases, although genomic DNA could not be detected. Beside the accumulation of solid epidermic particles the paper describes deposition of serous and fatty tissue fluid at the ligature (mainly adjacent to skin ridges).

Spectrophotometric measurements were performed on intra- and/or subcutaneous bruises occurring in direct temporal connection with peracute fatal trauma. The purpose of these measurements was to determine whether the visual colour impression of a fresh traumatic extravasation can give information on the localisation of the haemorrhage in a certain tissue layer. After visual assessment of the colour of the bruise, the spectral reflectance curves and the CIE-L*a*b* colour values were determined with the help of a diode array spectrophotometer. The localisation and size of the haemorrhages in the cutis and/or subcutis were evaluated morphologically after incision of the skin. It was confirmed that there is a relationship between the colour impression and the localisation of the bruise. Bruises localised near the surface have a more reddish appearance while bruises in deeper layers give a more bluish colour impression. An explanation may be found in the optical characteristics of skin. Blood localised in the subcutis appears blue on the surface due to scattering processes in the dermis (Rayleigh scattering), as the blue wavelengths of the light are scattered (and thus reflected) to a greater extent than the red wavelengths.

The time-dependent inflammatory cell reaction in human cortical contusions has been investigated during the first 30 weeks after blunt head injury. Immunohistochemical staining was carried out using CD 15 for granulocytes and LCA, CD 3 and UCHL-1 for mononuclear leucocytes. In order to provide reliable data for a forensic wound age estimation, the intensity of the cellular reaction was evaluated with a quantitative image analysis system. CD 15-labelled granulocytes were detectable earliest 10 min after brain injury, whereas significantly increased numbers of mononuclear leucocytes occurred in cortical contusions after a postinfliction interval of at least 1.1 days (LCA), 2 days (CD 3) or 3.7 days (UCHL-1), respectively.

The changes occurring during cremation were watched and documented in 15 undissected bodies to be cremated. It was found that at temperatures between 670 and 810 degrees C the body showed the "pugilistic attitude" after about 10 minutes. After 20 minutes the calvaria was free from any soft tissue and fissures of the tabula externa could be noticed. The body cavities became visible after approximately 30 minutes, so that the organs were exposed. Forty minutes after cremation had started, the internal organs were severely shrunken and showed a net-like or sponge-like structure. After about 50 minutes the extremities were destroyed to an extent leaving only the torso which broke apart after 1-1.5 hours. The complete incineration of a human body took about 2-3 hours.

Based on a recent case, in which an expert opinion had to be prepared, the question was investigated if fractures of the base of the skull can result from the influence of heat on the human skull. Neither the retrospective analysis of autopsy records nor the prospective examination of charred bodies revealed any cases with heat-induced fractures of the base of the skull. Observation of cremations showed that the changes caused by the fire followed certain rules: fractures of the calvaria were seen after approximately 20 min; the base of the skull became exposed after about 45 to 60 min. In none of the 20 cremations watched could any fractures of the base of the skull be detected.

Bernitz et al. published a paper on the protrusion of the tongue in burned bodies and were of the opinion that this was an indicator of vital burning [1]. The authors reported that in 63 of 107 fire fatalities, protrusion of the tongue was observed, whereas in 27 cases, this phenomenon was not seen. The authors compared this parameter with the presence of soot deposits in the respiratory tract and an elevated CO-Hb content in the corpse blood—the characteristic parameters of vitality. They found that in the vast majority of the cases with protrusion of the tongue, soot aspiration and CO-Hb values >10 % were also present. According to the authors, subsequently performed statistical tests (Fisher’s exact test, Mann–Whitney test, Kolgorov–Smirnov test) confirmed that protrusion of the tongue was a sign of vitality. This is a very bold conclusion. The authors ignore in their argumentation that most fire-related deaths show signs of vitality [1–6]. This has not only been demonstrated in various studies, but is also true in the 107 cases presented by Bernitz et al. [1]. Statistical comparison of two groups of such different sizes (vital versus avital burning) is questionable. However, in the discussion, this methodological problem is not even mentioned. Moreover, protrusion of the tongue and soot aspiration are findings very often seen in fire fatalities. For that reason alone, the probability that both parameters occur simultaneously is very high, although the mere coincidence of two parameters does not mean that they are of equal validity— in this case, that they are signs of vital exposure to fire. Apart from looking for a correlation between tongue protrusion and internal signs of vitality, one could then also look for a correlation between charring of the skin, pugilistic attitude or fire-related amputations and internal signs of vitality. In all probability, this approach would also produce positive correlations. By the way, the application of statistical methods would show the same significant results if the hypothesis were “Protrusion of the tongue is no vital sign and thus simultaneous soot aspiration is not either.” This obviously absurd statement could also be proved by the data material and tests used by the authors. In addition, there is no pathophysiological explanation whatsoever why protrusion of the tongue should be a sign of vitality. The statement that, after death, no physiological processes are going on which might explain protrusion of the tongue, does not really help, as it goes without saying that physiological processes always occur before death. Obviously, the authors were also aware (as the last sentence of the discussion chapter shows) that the pathophysiological processes should also be recorded. On the other hand, the assumption mentioned in the introduction that this may be a postmortem artefact due to the heat-related shrinking of the cervical soft tissue [7] is not addressed either in the methodology part or in the discussion. The essential parameter in this context would be to what extent the cervical soft tissue was burned, but this was not even recorded in the present study.

Our current research in the framework of an interdisciplinary project focuses on modelling the dynamics of the hemoglobin reoxygenation process in post-mortem human skin by reflectance spectrometry. The observations of reoxygenation of hemoglobin in livores after postmortem exposure to a cold environment relate the reoxygenation to the commonly known phenomenon that the color impression of livores changes from livid to pink under low ambient temperatures. We analyze the spectra with respect to a physical model describing the optical properties of human skin, discuss the dynamics of the reoxygenation, and propose a phenomenological model for reoxygenation. For additional characterization of the reflectance spectra, the curvature of the local minimum and maximum in the investigated spectral range is considered. There is a strong correlation between the curvature of specra at a wavelength of 560 nm and the concentration of O2-Hb. The analysis is carried out via C programs, as well as MySQL database queries in Java EE, JDBC, Matlab, and Python.

An 88-year-old woman committed suicide by drinking a toxic amount of highly concentrated alcohol and setting two rooms of her flat on fire. As there was not enough oxygen, the fire went out, however. At autopsy, no thermal lesions were found on the body, but soot depositions in the airways and a COHb value of 14% pointed to the inhalation of fire fumes. The ethanol concentration in femoral blood was 6.62 per mille. The gastric mucosa was fixed by the ingested alcohol and showed hardly any autolytic changes despite a post-mortem interval of five days. Congener analysis of the gastric contents and the femoral blood indicated the uptake of a fruit distillate or its foreshot.

Aims To investigate incipient inflammatory changes as first steps in the development of a systematic inflammatory response syndrome in the lungs of burn victims. Methods At the Institute of Legal Medicine of the University Hospital of Freiburg a collection of 40 forensic autopsy cases of burn victims was established that had died within 1 h after fire exposure. This group was compared with a total of 48 autopsy cases in three control groups (postmortem burns vs deaths from haemorrhagic shock vs railway suicide deaths). In all cases, immunohistochemical studies of lung tissue probes were performed to detect the presence of pro-inflammatory mediators using antibodies against tumour necrosis factor α (TNF-α), interleukin-8 (IL-8) and inter-cellular adhesion molecule 1 (ICAM-1). Results The lungs of burn victims showed a significantly higher extent of intra-alveolar oedema than the other groups. Immunohistochemically, macrophages in all groups mostly showed a distinct expression of TNF-α, but not of IL-8 or ICAM-1. Interestingly, intravascular erythrocytes often showed a positivity of TNF-α that was strongest in the group of burn victims and differed significantly from all the control groups. Conclusions In burn victims with short survival times of ≤1 h after fire exposure, the immunohistochemical expression profiles of TNF-α, IL-8 and ICAM-1 in the lungs were not altered enough to prove an instant inflammatory reaction in these cases. Nevertheless, the positive reaction of TNF-α in erythrocytes of burn victims may indicate the beginning of a non-specific immune response to fire-induced inhalation trauma.

A sudden death due to hemothorax caused by spontaneous rupture of a congenital pulmonary arteriovenous malformation (AVM) is reported. A 44-year-old woman died unexpectedly with chest pain and dyspnea. The post-mortem examination revealed a massive right-sided hemothorax arising from a subpleural AVM of the upper lobe. There were multiple telangiectases in the tongue and the tonsils, as typically associated with Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia, HHT). The post-mortem molecular genetic analysis proved the presence of a disease-causing mutation in the endoglin gene constituting a predisposition for pulmonary AVMs. According to the literature, almost half of the AVMs in the lung are seen in HHT patients. Based on the presented case and the relevant literature, the article addresses the forensic aspects of fatal hemothorax and the importance of detecting the source of bleeding.

A 48-year-old man died from extensive burns suffered especially on the upper part of the body during a dispute with his ex-wife, who had poured spirit or a spirit-water mixture over him. For initially unknown reasons, the man's clothing caught fire. Whereas the public prosecutor assumed that the woman had intentionally poured a larger amount of spirit over her ex-husband before setting fire to him, the defendant first claimed to have poured the rest of a water-spirit mixture left over from cleaning the windows over the man and that his clothing caught fire on lighting a cigarette. To clarify the course of events, fire tests with spirit in various dilutions were conducted, which showed that even with undiluted spirit a direct contact with the flame of at least 1 second is necessary to start a fire. There is no deflagration, if spirit is used as a fire accelerant. In the trial, the defendant made a confession and admitted to have poured a mixture of 75% spirit and 25% water over her ex-husband and set fire to his right sleeve with the intention to kill him.

In the western countries, the number of fatal intoxications with plant protecting agents has decreased to some extent due to laws restricting the use of highly toxic pesticides like halogenated hydrocarbons. Nevertheless, in consideration of the easy availability of most plant protectants, the small fraction of such fatalities among suicides and intoxications is astonishing. An 80-year-old woman died of an intoxication with methiocarb (mercaptodimethur), a carbamate type pesticide and as such a reversible inhibitor of the acetylcholinesterase. The case is presented because it is the first explicit report on a fatal poisoning of a human with methiocarb. The methiocarb concentrations detected were 6,100 microg/g in stomach content, 4.0 microg/ml in heart blood, 11 microg/g in kidney, 1.9 microg/ml in urine, 25 microg/g in liver, 2 microg/g in bile and 2.5 microg/g in brain tissue.

For comparative examination of the pathological findings in burn shock and hemorrhagic shock, histological and immunohistochemical investigations of the lungs were performed. Histological specimens of 30 cases each were examined by means of immunohistological staining with P-selectin, von Willebrand factor (vWF) and PECAM-1. The results showed statistically significant differences between the two groups. There was strong staining for P-selectin (especially in the lumina of the blood vessels) and vWF (especially in the endothelium of medium-sized blood vessels) in the specimens of burn shock fatalities. In cases of rapid death after exposure to fire the strong expression of adhesion molecules, which are mainly responsible for the initial inflammatory reaction of leucocytes and platelets in burn shock, suggests prompt activation of inflammatory cells in the lung tissue. In cases of hemorrhagic shock, this reaction was much less distinct in the early stages. The same is true of the expression of PECAM-1, which was lower in lungs from burn shock fatalities than in those from hemorrhagic shock fatalities. The low expression of PECAM-1 in burn shock is a clue to the migration/diapedesis of leucocytes into the areas of burn damage. In total, the results of the investigation indicate different pathophysiological processes even in the very early stages of burn shock and hemorrhagic shock.

When a body is exposed to a cold environment, the livid colour of livor mortis changes to cherry red. This colour change is due to an increase in the concentration of oxygenated haemoglobin. The chronological course and the extent of haemoglobin re-oxygenation associated with the exposure to low ambient temperatures have not been understood so far. The relations between refrigeration time under a constant ambient temperature (5 degrees C), skin temperature, body mass index (BMI), spectral reflectance curve and O2-Hb concentration in livor mortis were systematically investigated in 84 bodies brought to the Institute of Legal Medicine of the Freiburg University Hospital shortly after death. In the first measurements performed shortly after death, the reflectance curves of the livores of all bodies showed a broad minimum at 555 nm. After a refrigeration time of 44.9 +/- 17.9 h, the spectrum changed to the typical picture of O2-rich blood with 2 minima at 541 and 576 nm and a maximum at 560 nm in between. This qualitative change of the reflectance spectra was observed for a skin temperature of 10.3 +/- 2.7 degrees C. With the help of a physical skin model it was possible to calculate that due to the post-mortem exposure to cold the O2-Hb concentration in the livores rose from 0-1% to a value of up to 89.3%. The change in the reflectance curve was discernible from an oxygen saturation of 25 +/- 13.8%.

Immunohistochemical investigation of the respiratory tract and lungs of 63 fire victims revealed a statistically significant enhanced expression of heat-shock protein 70 (Hsp70) in the epiglottis, the trachea, and the main and the peripheral bronchi compared with a control group. In the fire victims, a strong expression of Hsp70 was discernible not only particularly in the vessels but also in seromucous secretory cells, ciliated epithelial cells, smooth muscle cells, and alveolar cells. The results suggest a vital or supravital reaction due to the inhalation of hot fire fumes.

If autopsy findings in an infant show traumatic changes on the skullcap, these are not always the result of a postnatal trauma due to child abuse, a fall or another accidental event. With regard to differential diagnosis a birth trauma should also be kept in mind, so that the history of the delivery is important. The spectrum of possible residues after vacuum extraction (circular fracture and/or elevation of the outer table of skull bones, subperiostal and intraossal haematoma, extradural and subdural haemorrhage) is demonstrated by means of three examples from the forensic autopsy material.

Within a period of 9 years a young woman lost 3 daughters during infancy and each time death was attributed to the sudden infant death syndrome. The children had different fathers and died at the ages of 11 weeks, 7 weeks and 2 weeks, respectively. A fourth daughter survived and lives separated from the mother together with her father and is healthy. At autopsy the last of the three deceased infants did not reveal any pre-existing pathological organ findings, except for acute pulmonary emphysema and extensive intra-alveolar bleeding. As a consequence the strong suspicion of mechanical suffocation arose. Subsequent police investigations produced incriminating clues that the first two children had also been suffocated. On confrontation with the autopsy findings and investigation results, the woman confessed that she herself had killed the first two infants by pressing a cushion on their faces. In the case of the third death the baby had been smothered by the child’s father who in agreement with the mother put a plastic film on mouth and nostrils.

Rhabdomyolysis has repeatedly been reported as a possible consequence of illicit drug consumption especially in clinical literature. In order to investigate the prevalence of rhabdomyolysis in cases of drug deaths, immunohistochemical staining of kidney sections with a myoglobin antibody was performed at 103 consecutive fatal drug poisonings. The control group consisted of 107 unselected forensic autopsies. With regard to the presence of intratubular myoglobin, 33% of the study group were categorized as "strongly positive", 17.5% as "slightly positive" and 49.5% as "negative". No single substance showed a particularly high incidence of rhabdomyolysis nor were there correlations to special combinations of substances. In the control group a "strongly positive" result after myoglobin staining was observed in only 10.3% of 107 cases, a "slightly positive" result in 13.1% and a "negative" result in 76.6%. The findings suggest that rhabdomyolysis is a frequent consequence of illicit drug consumption and that it is not promoted by a single factor, but by a combination of several factors.

Among the few cases of suicidal self-incineration primary or secondary complex suicides are a rarity. Accordingly the number of reports on this subject in the forensic literature is small. In a retrospective analysis of the Freiburg and Berlin autopsy material, four cases were found within an observation period of 11 years. These are described together with seven other cases reported in the literature. Altogether most of these suicides are primary combinations, especially with falls from a height. Other combinations include hanging or the infliction of stabs, cuts or gunshot injuries. The sex and age distribution is similar to that found for suicide by self-incineration alone.

In the forensic literature the opinion is often held that the presence of aqueous liquid in the paranasal sinuses in conjunction with other findings (plume of froth around the mouth and nostrils, emphysema aquosum, Paltauf's spots, increased haemolysis etc.) can be regarded as a sign of drowning. Especially the sphenoid sinus is easily accessible at autopsy; its content can be aspirated from the base of the skull with a cannula. The valency of the liquid content in the sphenoid sinuses was consecutively investigated in 60 deaths by drowning and 157 other deaths. The results showed that in 92% of the deaths by drowning between 1 ml and 4 ml of aqueous fluid could be found in the sphenoid sinuses. However, a positive result was also obtained in 52% of the other cases autopsied, but in the control group the average volume of the aspirate was smaller than in the group of deaths by drowning.

One hundred consecutive drug death victims autopsied at the Institute of Forensic Medicine, University of Freiburg, between 1995 and 1997 were studied retrospectively as to whether the drug users had also consumed nicotine. The study included histological examination of the lung tissue for smoker cells and radioimmunological as well as GC-MS assays of the urine for cotinine, the primary metabolite of nicotine. It was found that 98 out of 100 drug victims had consumed nicotine in addition to illicit drugs or replacements. Yellowish-brown discolorations on the middle and index fingers were discernible in 44 drug victims, whereas fresh or scarred burns due to glowing cigarettes were found in six deceased drug consumers. Diseases of the bronchial system typical of heavy smokers were seen in 35 cases. Siderophages could be demonstrated in 17 of the 100 drug deaths.

Under low ambient temperatures normally bluish postmortem lividity adopts a bright red or pink colour due to resaturation of haemoglobin with O2. The most important differential diagnosis in the presence of pink hypostasis is carbon monoxide poisoning. To answer the question if objective measuring methods allow differentiation of hypostasis with regard to cold exposition or carbon monoxide poisoning, spectrophotometric measurements were performed and the colorimetric measures as well as the spectral reflectance curves of the postmortem lividity were determined. The colorimetric measures CIE-L*a*b* showed similar values for all bright red livores mortis; differentiation between CO intoxication and cold exposition was not possible. Reflectance curves of pink hypostasis after cold storage showed the typical pattern of O2-rich blood with reflectance minima at wavelengths 541 nm and 576 nm and a reflectance maximum at 560 nm. Pink hypostasis because of carbon monoxide poisoning showed a shift of the reflectance maximum toward 555 nm and a flattened curve in all cases with COHb concentrations exceeding 52%, whereas these changes were not regularly observed with lower COHb levels.

The application of ultraviolet light in forensic practice is a well-tested method to visualise traces or skin alterations. When viewing myocardial sections under UV light at autopsy, bluish-white fluorescent areas became visible that could not be detected in the seemingly homogenous myocardium in daylight. A systematic comparison of the macroscopic cardiac findings and the pertinent histological sections showed that in all cases with a positive UV fluorescence myocardial fibrosis or lipomatosis could be confirmed by histological methods. The examination for UV fluorescence of the myocardium seems to be a simple and rapid method improving the macroscopic perceptibility of fibrotic changes and minor scars.

The relationship between cognitions and anxiety was studied in 32 patients with anxiety neurosis. The thoughts and fantasies associated with the arousal and intensification of anxiety were mainly anticipation of physical harm, such as being violently attacked, being involved in an accident, or becoming sick; and anticipation of psychosocial trauma, ranging from humiliation or rejection in certain circumstances to complete ostracism. The patients' idiosyncratic ideation involved unrealistically heightened expectations of harm; the degree of anxiety was related to the degree of credibility of the fears (to the patient) and severity of the anticipated adversity. Of 24 patients specifically questioned about having visual images, 22 reported having typical fantasies of being in danger prior to and concomitant with their anxiety attacks. Verbal cognitions related to danger were reported in all cases.