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Despite the benefit of safety vests to the reduction of torso injuries in children and adolescents is unclear, its’ use is recommended. The aim of the present study is to determine the effectiveness of safety vests actually used in pediatric equestrian activities. In this case-control-study, we analyzed the accidents of 92 riders aged 18 or younger who fell off a horse onto his/her torso during a period of 18 months. Data were gathered from the clinical records. Additionally, a questionnaire was administered on the day of trauma by the patients and/or their parents. The cases comprised 31 patients who sustained torso injuries. The controls were 61 riders with injuries of other body parts than to the torso. Safety vest use was not associated with a lower risk of torso injuries (OR=1.18, 95% CI (0.50, 2.81), p=0.707). Post hoc power analysis revealed that within such a setting an odds ratio of 0.266 could be found with a power of 80%. This study is not able to show an association between wearing a torso protector and protection from torso injuries, probably due to confounding. We did not detect a high effect of safety vest usage in our study population. Whether the development of a new generation of safety vests might be more effective remains unclear. An effective vest should be adapted to the requirements of children and adolescents and should protect the thorax and abdomen, but also the cervical and the lumbar spine.

Intracranial arteriovenous malformations (AVMs) are cerebrovascular abnormalities due to maldevelopment of the regional capillary bed, producing lesions with arteriovenous shunting. AVMs may account for as many as 1% of all sudden deaths; however, case reports in the literature are exceedingly rare. We present 3 cases of sudden death due to hemorrhage of AVM and discuss the literature and the differential diagnosis in cases of sudden death due to intracranial hemorrhage.

The purpose was to analyze magnetic resonance (MR) plaque imaging at 3.0 Tesla and 1.5 Tesla in correlation with histopathology. MR imaging (MRI) of the abdominal aorta and femoral artery was performed on seven corpses using T1-weighted, T2-weighted, and PD-weighted sequences at 3.0 and 1.5 Tesla. Cross-sectional images at the branching of the inferior mesenteric artery and the profunda femoris were rated with respect to image quality. Corresponding cross sections of the imaged vessels were obtained at autopsy. The atherosclerotic plaques in the histological slides and MR images were classified according to the American Heart Association (AHA) and analyzed for differences. MRI at 3.0 Tesla offered superior depiction of arterial wall composition in all contrast weightings, rated best for T2-weighted images. Comparing for field strength, the highest differences were observed in T1-weighted and T2-weighted techniques (both P< or =0.001), with still significant differences in PD-weighted sequence (P< or =0.005). The majority of plaques were histologically classified as calcified plaques. In up to 21% of the cases, MRI at both field strengths detected signal loss characteristic of calcification although calcified plaque was absent in histology. MRI at 3.0 Tesla offers superior plaque imaging quality compared with 1.5 Tesla, but further work is necessary to determine whether this translates in superior diagnostic accuracy.

Injuries caused by explosions of fireworks often involve people's hands. The case of a young man who suffered severe hand injuries as well as damage to both eardrums and one eye is described. Reconstructive experimental investigations of the explosive effect of six different pyrotechnic articles were carried out using human hands from body donors. With the most powerful firecrackers that used to be legally available in Germany ("Super-Böller A", "Kanonenschlag") and a self-made one with 36 g gunpowder only blackening of the skin occurred. Three pyrotechnic articles not allowed in Germany ("La Bomba", "Color salute" and "Vogelschreck") caused serious injury to the hand's soft tissue and bones.

The vocal ligaments insert at the anterior and posterior commissures of the larynx. These structures fulfil biomechanical functions, balancing the different elastic moduli of tendon, cartilage or bone and undergo age-related changes that may be responsible for voice changes with increasing age. The aim of this study was to analyse the insertion structures of the vocal ligaments by means of macroscopic, histological, immunohistochemical and electron-microscopic methods and to draw conclusions from age-related structural changes on a functional basis. Investigations were carried out on the larynges of 22 males and 15 females (aged 1–95 y). In adolescence, the insertion zone of the vocal ligament tendon, a dense network of connective tissue rich in sulphated glycosaminoglycans at the thyroid cartilage, is characterised by a layer between tendon and cartilage comparable to fibrocartilage. The insertion zone lacks a perichondrium. Collagen fibrils of the vocal ligament tendon penetrate directly into the thyroid cartilage. In the insertion area, the chondrocytes are surrounded by collagen fibrils, which show positive reactivity to antibodies against type I and type III collagen. Sulphated glycosaminoglycans are integrated between the collagen fibrils. In the area of the posterior glottis, elastic cartilage rests like a cap on the hyaline base of the arytenoid cartilage. There is no distinctive border between the structures. With increasing age, ossification of the laryngeal skeleton occurs, involving hyaline cartilage at the posterior glottis and hyaline and fibrocartilage at the anterior commissure. At the same time, a loss of sulphated glycosaminoglycans is observed inside the vocal ligament tendon. Advanced ossification of the laryngeal skeleton, particularly in the area of the commissures, an increasing loss of glycosaminoglycans in the vocal ligament tendon and changes in the elastic tissue reduce the elastic modulus between tendon, cartilage and bone, thus ‘stiffening’ the insertion zones, which could be one factor among others favouring voice changes with advancing age.

We present three unusual cases of fatal bleeding from eroded femoral blood vessels. Erosion was due to tumor metastases in one and abscess formation in two cases. Bleeding occurred from the femoral vein in two cases and from the femoral artery in one case. Extensive bloodstains at the death scene were suspicious of homicide, which was ruled out by medico-legal autopsy in all cases.

The authors report on the suicide of a 27-year-old woman with extreme self-inflicted injuries. The victim suffered from schizophrenic psychosis with several stays in mental institutions and one previous suicide attempt. Autopsy revealed multiple cut and stab injuries in various body regions (51 stabs to the chest, cutting off parts of ears and nose, stab to the eye and transection of the scalp). Death was caused by exsanguination.

OBJECTIVE:: To analyze horse-related accidents caused by hoof kicks. DESIGN:: Prospective study to evaluate hoof kick-related accidents. SETTING:: Multicenter study, including 9 trauma centers in Hamburg, Germany. PATIENTS:: Patients who were treated as the result of a hoof kick between January 1, 2010 and May 1, 2010 were included in the study. MAIN OUTCOME MEASURES:: Horse and rider qualifications, riders' use of protective equipment, location and activity at time of accident, mechanism of injury, injuries sustained, and treatment required for these injuries. RESULTS:: Twenty-four equestrians received hoof kicks. The average age was 22.6 years (range, 7-34 years). All accidents (100%) occurred while the equestrians were handing or grooming the horse. Two riders (8.3%) wore a helmet at time of accident. Sixteen riders (66.7%) suffered orbital, midface, or mandible fractures; 8 riders (33.3%) had injuries on other parts of the body. CONCLUSIONS:: Hoof kick injuries account for a significant proportion of equine injuries and occur when riders are dismounted, most frequently when grooming without wearing protective equipment. Head and facial injuries occur most frequently and suggest that mandatory helmet and facial grill use should be considered during all horse-related activities. Language: en

Splenic artery aneurysms are an uncommon form of vascular disease that have a significant potential for rupture, resulting in life-threatening intraperitoneal hemorrhage. We describe the case of a 33-year-old man who died suddenly and unexpectedly due to the rupture of a splenic artery aneurysm. At medicolegal autopsy, 3000 mL of fluid blood were recovered from the peritoneal cavity. The source of bleeding was a sack-like aneurysm of the splenic artery, measuring 2 cm in diameter. Histologic examination of the splenic artery aneurysm revealed fibromuscular dysplasia. No atherosclerotic lesions or any inflammatory changes were apparent within the wall of the splenic artery. Portal hypertension and pancreatitis, previously described as important factors promoting splenic artery aneurysm formation, were excluded by autopsy and histology. From the forensic pathologist's viewpoint, this rare case underlines the importance of splenic artery aneurysm rupture as a relevant differential diagnosis of intraperitoneal hemorrhage and sudden death, respectively, since such cases may be misinterpreted as a result of blunt-force trauma.

The HIV-status of 3999 fatalities (aged 1-60 years) examined at the Institute of Forensic Medicine in Hamburg from 1989-1992 was tested. Former predictions of an enormous increase of HIV-infections, especially in the risk group of IVDA (intravenous drug addicts), did not come true. HIV-screening of fatalities is an instructive additional method of gaining information about the epidemiological development of HIV-infections.

The serum myoglobin levels of 58 fatalities were investigated with special reference to correlations of the myoglobin-concentrations with the postmortem interval, the site of blood sampling and the cause of death (especially concerning death caused by electric current). An increase of the myoglobin values with the passage of postmortem time is obvious. The topographical sampling site plays an important role; the highest concentrations are found adjacent to striated muscles (i.e. in blood from the heart or the femoral vein). There was no significant correlation of myoglobin values and death by electric current.

Since 1985 several European Institutes of Forensic Medicine have cooperated in a multicenter study providing a constant monitoring of HIV-1 prevalence among drug-related deaths. From 1985 to 1991 the HIV status of 5372 drug-related fatalities (4328 males, 1044 females) has been tested. A total of 764 (14%) drug deaths were HIV-positive (13% of the males, 21% of the females). In contrast to the steadily increasing number of drug-related fatalities the HIV-1 prevalence is decreasing, especially in the German cities. Regional differences are obvious. The development of the HIV prevalence of drug deaths is comparable with that of the still living intravenous drug addicts.

According to literature, siderophages are a characteristic histological finding in the lung of deceased drug addicts (IVDA). It was the aim of our study to evaluate their pathognomonic significance. The lungs of 591 drug deaths in Hamburg were examined histologically for siderophages in two series, with different ‘Berlinerblau’ (Prussian blue) staining methods. The first series (investigation period 1980–1990) showed iron-containing macrophages in 36 of 420 drug deaths (8.6%) compared with a control-group (healthy young persons dying from unnatural causes of death) in which only one was positive (2%). In a second series, using a more sensitive staining method, 80 of 171 drug deaths (47%) in the year 1991 showed siderophages, whilst in a control-group, 17 of 35 cases (49%) were positive. According to our findings the pathognomonic value of siderophages in the lung of IVDA is doubtful. There is a need for further histochemical and ultrastructural investigations concerning the morphology and etiology of pulmonary macrophages in IVDA.

Since 1985, a number of Institutes of Forensic Medicine in Germany have cooperated in a multicenter study, to provide a constant monitoring of HIV-1-prevalence among drug related deaths. In 1990/91, the Institutes in Copenhagen, Stockholm, Vienna and Zurich also participated in this study. HIV-1-prevalence is decreasing in the German cities, whereas the epidemiological development is not uniform in the other major cities. Regional differences are obvious. In 1991, the prevalence rates were as follows: Berlin 15% (n = 220), Hamburg 4% (n = 179), Frankfurt 17% (n = 167), Munich 9% (n = 136), Stockholm 10% (n = 79), Copenhagen 14% (n = 130), Vienna 20% (n = 56), and Zurich 23% (n = 84).