Search

The aim of this study was to describe the circumstances surrounding firework-related deaths in Denmark, locate similarities and compare findings to the other known literature. Autopsy files, including police reports, located through searches in the archives of the three Danish institutes of forensic medicine were accessed. Data describing the age, gender, toxicology findings, circumstances of the accident, cause of death, autopsy findings and type of fireworks were examined. Eight cases involving firework-related deaths matched the search criteria, two of which occurred on New Year's Eve. An unknown number of cases that had not been autopsied were confirmed to exist. Data from the included cases suggested that using illegal fireworks, being male and handling fireworks directly played a key role in deaths. Most notably, illegal fireworks account for few injuries overall but caused the most deaths found in this study. Firework-related deaths are a rare occurrence. Autopsy findings often reveal blast wave injury to be the cause of death. Only one of the eight decedents included in this study were intoxicated with alcohol. Thus it can be assumed that powerful illegal fireworks are, by themselves, a risk factor for a deadly accident, independent of alcohol intoxication.

Conversion therapy is a set of practices that aim to change or alter an individual’s sexual orientation or gender identity. It is premised on a belief that an individual’s sexual orientation or gender identity can be changed and that doing so is a desirable outcome for the individual, family, or community. Other terms used to describe this practice include sexual orientation change effort (SOCE), reparative therapy, reintegrative therapy, reorientation therapy, ex-gay therapy, and gay cure. Conversion therapy is practiced in every region of the world. We have identified sources confirming or indicating that conversion therapy is performed in over 60 countries.1 In those countries where it is performed, a wide and variable range of practices are believed to create change in an individual’s sexual orientation or gender identity. Some examples of these include: talk therapy or psychotherapy (e.g., exploring life events to identify the cause); group therapy; medication (including anti-psychotics, anti- depressants, anti-anxiety, and psychoactive drugs, and hormone injections); Eye Movement Desensitization and Reprocessing (where an individual focuses on a traumatic memory while simultaneously experiencing bilateral stimulation); electroshock or electroconvulsive therapy (ECT) (where electrodes are attached to the head and electric current is passed between them to induce seizure); aversive treatments (including electric shock to the hands and/or genitals or nausea-inducing medication administered with presentation of homoerotic stimuli); exorcism or ritual cleansing (e.g., beating the individual with a broomstick while reading holy verses or burning the individual’s head, back, and palms); force-feeding or food deprivation; forced nudity; behavioural conditioning (e.g., being forced to dress or walk in a particular way); isolation (sometimes for long periods of time, which may include solitary confinement or being kept from interacting with the outside world); verbal abuse; humiliation; hypnosis; hospital confinement; beatings; and “corrective” rape. Conversion therapy appears to be performed widely by health professionals, including medical doctors, psychiatrists, psychologists, sexologists, and therapists. It is also conducted by spiritual leaders, religious practitioners, traditional healers, and community or family members. Conversion therapy is undertaken both in contexts under state control, e.g., hospitals, schools, and juvenile detention facilities, as well as in private settings like homes, religious institutions, or youth camps and retreats. In some countries, conversion therapy is imposed by the order or instructions of public officials, judges, or the police. The practice is undertaken with both adults and minors who may be lesbian, gay, bisexual, trans, or gender diverse. Parents are also known to send their children back to their country of origin to receive it. The practice supports the belief that non-heterosexual orientations are deviations from the norm, reflecting a disease, disorder, or sin. The practitioner conveys the message that heterosexuality is the normal and healthy sexual orientation and gender identity. The purpose of this medico-legal statement is to provide legal experts, adjudicators, health care professionals, and policy makers, among others, with an understanding of: 1) the lack of medical and scientific validity of conversion therapy; 2) the likely physical and psychological consequences of undergoing conversion therapy; and 3) whether, based on these effects, conversion therapy constitutes cruel, inhuman, or degrading treatment or torture when individuals are subjected to it forcibly2 or without their consent. This medico-legal statement also addresses the responsibility of states in regulating this practice, the ethical implications of offering or performing it, and the role that health professionals and medical and mental health organisations should play with regards to this practice. Definitions of conversion therapy vary. Some include any attempt to change, suppress, or divert an individual’s sexual orientation, gender identity, or gender expression. This medico-legal statement only addresses those practices that practitioners believe can effect a genuine change in an individual’s sexual orientation or gender identity. Acts of physical and psychological violence or discrimination that aim solely to inflict pain and suffering or punish individuals due to their sexual orientation or gender identity, are not addressed, but are wholly condemned. This medico-legal statement follows along the lines of our previous publications on Anal Examinations in Cases of Alleged Homosexuality1 and on Forced Virginity Testing.2 In those statements, we opposed attempts to minimise the severity of physical and psychological pain and suffering caused by these examinations by qualifying them as medical in nature. There is no medical justification for inflicting on individuals torture or other cruel, inhuman, or degrading treatment or punishment. In addition, these statements reaffirmed that health professionals should take no role in attempting to control sexuality and knowingly or unknowingly supporting state-sponsored policing and punishing of individuals based on their sexual orientation or gender identity.

The majority of homicides in the world are caused by firearms and a good understanding of gunshot wounds is important for the forensic pathologist. We have analyzed all 315 homicides by gunshots in Denmark during 1992-2016 with focus on information relevant to forensic pathologists. Of the 1417 homicides in Denmark in 1992-2016, 315 (22.2%) had gunshot trauma as the primary homicide method. During 1992-2016, there has been a significant decrease in the number of gunshot homicides overall, of homicides committed with hunting weapons, and of domestic gunshot homicides. Most victims (70.5%) and offenders (93.7% of homicides with known offenders) were males. Male victims were significantly younger than female victims. Most victims were killed with handguns (43.8%) or shotguns (41.0%). Compared to all other weapons, the victims killed with shotguns had fewer entry wounds, a higher New Injury Severity Score (NISS), and a higher proportion of contact/close-range entry wounds. The head (58.1%) and thorax (46.7%) were often injured, with injuries to the head being more common in contact/close-range entry wounds. The results show that gunshot injuries in homicides are different from suicides and accidents and clearly are affected by the homicide type, the sex of the victim, and the weapon used and that these entities are intertwined. Our findings provide an evidence-based foundation for use in death investigations and for policy development in the area of interpersonal violence.

Sharp force trauma is a common homicide method. The weapon is typically a knife, which is easily accessible and does not require special skills. We have analyzed all 471 sharp force homicides in Denmark during 1992-2016 with special focus on aspects that are relevant to forensic pathologists, including the distribution of wounds and organ injuries. Most homicides were committed inside with a kitchen knife. The front left thorax was the most common area to be affected by sharp force trauma. In 18.9% of the victims, there was only one sharp injury, the majority on the thorax. The most common trajectory for stab wounds was directly posterior with no deviation to the sides or up/down followed by directly anterior. The heart (including pericardium) and lungs (including hemo- and pneumothorax) had injuries in more than 75% of the victims. 67% of victims were males. Female victims had more sharp force injuries and defense wounds than male victims. Most females were killed in domestic homicides (73.7%), most commonly in partner killings (56.4%). In contrast, many male victims were killed in a setting of nightlife/intoxication (34.0%) most by a friend/acquaintance delivering a few stab wounds. The results clearly show strong sex differences in both victims and offenders. This could be useful for shaping policies and public opinion, and as a route for understanding the developments in interpersonal violence. In the narrow setting of death investigation, our results will provide an evidence-based approach to understanding the injury patterns in sharp force homicide.

Patients suffering from psychiatric disorders have an excess mortality and a shorter life span expectancy compared to the general population. Furthermore, they are treated with multiple drugs and are known to have an increased risk of drug abuse. In this study, we aimed at investigating the pharmaceutical drug and drug of abuse profiles of the deceased included in the Danish prospective autopsy-based forensic study on psychiatric patients, SURVIVE. Using the postmortem systematic toxicological analysis results, we identified 129 different consumed compounds in our population (n = 443). Polypharmacy (≥5 compounds) was detected in 39.5% of the deceased. Deceased with a psychiatric diagnosis or who died from a fatal intoxication had significantly more compounds at the time of their death compared to having either no psychiatric diagnosis or another cause of death, respectively. Evidence of drug abuse was present, as 29.8% of our total population had consumed either methadone or illicit drugs of abuse, excluding tetrahydrocannabinol. Of those deceased with a psychiatric diagnosis, 33.6% had either consumed methadone or illicit drugs of abuse, a greater number than those without a psychiatric diagnosis. Fatal intoxication was the most frequent cause of death (40.6%) with methadone as the major intoxicant. Here, we found that those without a psychiatric diagnosis had fewer fatal pharmaceutical drug intoxications compared to the psychiatric diagnosis groups. Our findings add further context to understanding the excess mortality of psychiatric patents, since there is an increased occurrence of fatal intoxication, polypharmacy, and drug abuse in this population.

Objective: The aim of this descriptive cohort study was to characterize stranger rape compared to other types of rape. Method & Materials: All cases of women aged 12 years or older, who contacted a Center for Victims of Sexual Assault in the region of Southern Denmark and underwent a forensic examination in 2018, were collected and analyzed. Descriptive frequencies, Pearson's χ2-test and Fisher's exact-test were performed. Results: Compared to other types of rape, stranger rape were reported to the police more frequently, earlier and more frequently independently, without contact to family, friends or other authorities. In cases of stranger rape women were exposed to threats and violence more often, and clinical findings were found to coincide with the women's report more frequently. Regarding the offenders' level of planning, it was not possible to find significant differences between stranger rape and other rape types by comparing frequencies of the offenders' use of condoms and weapons and/or other remedies as surrogate markers for degree of planning. Conclusion: There were several significant characteristic differences between stranger rape and other types of rape. Characterizing the ‘archetypical rape’ in opposition to other and more frequent types of rape, may give the public, the police, the courts and aid organizations the background needed to understand the importance of rape typologies when handling cases of sexual assault.

In this case report, a 53-year old man died after ten days with fever and coughing and was tested positive for coronavirus disease 2019 (COVID-19). A post-mortem CT disclosed ground-glass opacities with focal consolidation in both lungs. At autopsy, the lungs were dark and heavy with increased consistency and without pleural fibrin. Microscopy of lung tissue showed diffuse alveolar damage with hyaline membranes, sparse chronic interstitial inflammation and foci of bronchopneumonia. The deceased was a non-smoker, who did not suffer from a serious illness. He was overweight (BMI = 34 kg/m2), an emerging predictor for poor outcome of COVID-19.

Freezing as a method for hiding a body is rare. We report here a homicide case in which three bodies were concealed in a freezer. This presented the pathologist with the problem of how to thaw the bodies and simultaneously avoid decomposition of the uppermost body. The problem was solved by slow thawing in a refrigerated morgue and by removing the bodies one after the other from top to bottom. The victims were a 27-year old mother and her two daughters, 7 and 9 years of age. The perpetrator was the 34-year old now-divorced husband and father. All were refugees from Syria. The perpetrator fled back to Syria. He was later arrested in Syria, confessed the crime and was sentenced to life imprisonment. The autopsy findings is discussed and compared to finding reported in the scientific literature.

Aims: Several drugs increase the risk of ventricular fibrillation and sudden cardiac death (SCD). We aimed to investigate in detail the toxicological findings of all young SCD throughout Denmark.Methods and results: Deaths in persons aged 1-49 years were included over a 10-year period. Death certificates and autopsy reports were retrieved and read to identify cases of sudden death and establish cause of death. All medico-legal autopsied SCD were included and toxicological reports collected. Positive toxicology was defined as the presence of any substance (licit and/or illicit). All toxicological findings had previously been evaluated not to have caused the death (i.e. lethal concentrations were excluded). We identified 620 medico-legal autopsied cases of SCD, of which 77% (n = 477) were toxicologically investigated post-mortem, and 57% (n = 270) had a positive toxicology profile. Sudden cardiac death with positive toxicology had higher rates of sudden arrhythmic death syndrome (SADS), compared with SCD with negative toxicology (56% vs. 42%, P Conclusion: We found that more than half of all toxicologically investigated SCD victims have positive post-mortem toxicological findings, and polypharmacy is displayed in a considerable proportion. SCD with positive toxicology had higher rate of SADS, suggesting that the compounds may play a proarrhythmic role in these cases.

Decapitation is an occurrence only rarely encountered in forensic medical practice. This fatality is generally most often described in pedestrians who have been run over by trains accidently or in cases of suicide, or alternatively in occupants of cars involved in high speed vehicle collisions. We report, for the first time, a case of a complete decapitation of a pedestrian as a consequence of a traffic accident. Due to a thorough medico-legal investigation of the body and the involved vehicle, we were able to reconstruct the unique dynamics of the accident and the mechanism of injury.

Suicide using a combination of a plastic bag over the head and inhalation of a non-irritating gas, such as helium, argon or nitrogen, has been reported in the literature. Here an unusual suicide method in a 17-year old man by suffocation from covering the face with household plastic wrap, combined with nitrous oxide inhalation, is presented. The case was reviewed based on police, autopsy and hospital reports. A PubMed search for scientific literature related to nitrous oxide abuse and suicide by suffocation was performed and our findings discussed in relation to the scientific literature found. The deceased was a 17-year old man who was found with the nose and mouth closed with a piece of kitchen plastic wrap. The plastic wrap had been removed prior to autopsy. Autopsy findings were suggestive of asphyxia, but were otherwise negative. Nitrous oxide was detected in the brain and lung tissue with headspace-gas chromatography-mass spectrometry (headspace-GCMS). The cause of death was assumed to be suffocation caused by plastic wrap covering the face, combined with nitrous oxide inhalation. Suicide was suspected because of a history of depression for several months. Nitrous oxide, also known as laughing gas, has a euphoric effect and is used as a recreational inhalant drug that can be purchased legally. Deaths caused by recreational nitrous oxide abuse are rare but may occur if used in combination with a plastic bag over the head. This is the first report of suicide by suffocation by external obstruction combined with nitrous oxide inhalation.

Aortic coarctation (AC) is a congenital aortic narrowing. We describe for the first time the findings obtained by unenhanced post mortem computed tomography (PMCT) in a case where the death was caused by cardiac tamponade from a ruptured aneurysmal dilatation of the ascending aorta and the aortic arch without dissection combined with aortic coarctation. The patient, a 46-year-old man, was found dead at home. PMCT showed haemopericardium and dilatation of the ascending aorta and the aortic arch. This appearance led to the mistaken interpretation that the images represented a dissecting aneurysm. The autopsy showed instead a thin-walled and floppy dilatation of the ascending aorta and aortic arch with a coarctation just proximal to the ligamentum arteriosum. A longitudinal tear was found in the posterior aortic wall just above the valves. Blood in the surrounding soft tissue intersected with a large haematoma (1000 ml) in the pericardial sac. Cardiac hypertrophy (556 g) was observed in the patient, though no other cardiovascular abnormalities were found. Histological analysis showed cystic medial necrosis of the ascending aortic wall. A ruptured aneurysmal dilatation of the ascending aorta and the aortic arch without aortic dissection associated with AC is an uncommon cause of haemopericardium that has only been described a few times before. The case is discussed in relation to other reported cases and in the context of the present understanding of this condition.

During a 10-year period (1980-1989), at least 43 cases of self-incineration with lethal outcome took place in Denmark. The incidence seems to be increasing: 11 cases took place in the first 5 years and 32 cases in the last 5 years. An even sex ratio as found (male:female = 23:20). The median age was 43 years, with a broad age range (20-87). Many incidents of self-incineration as a form of political protest were reported in the press especially during the 1960s and 1970s, and the press reports often inspired others to commit suicide in the same way. None of the cases in our investigation were politically motivated or reported in the press, and only one case could have been inspired by another similar case. Other investigations have shown that self-incineration is more common in some cultures than in others, and many have found that a religious motivation was common. In our investigation, all victims were of Danish origin, and a religious motive played no significant role. Most of the victims were suffering from mental illness, and a majority had tried to commit suicide before. None of the victims left a suicide note. The scene was most often at home and indoors--only a minority committed suicide in remote areas of the countryside. Most were found dead at the scene, and the cause of death was usually heat exposure. Only a minority had a lethal carboxy-hemoglobin (CO-Hb) concentration. It is concluded that close cooperation between police, fire experts, and the forensic pathologist is necessary to permit a correct classification of the mode of death in these cases.

OBJECTIVES:: The purpose of this investigation is to evaluate the value of postmortem computerized tomography (CT) for Abbreviated Injury Scale (AIS) scoring and Injury Severity Scoring (ISS) of traffic fatalities. MATERIAL:: This is a prospective investigation of a consecutive series of 52 traffic fatalities from Southern Denmark that were CT scanned and autopsied. The AIS and ISS scores based on CT and autopsy (AU) were registered in a computer database and compared. Kappa values for reproducibility of AIS-severity scores and ISS scores were calculated. RESULTS:: On an average, there was a 94% agreement between AU and CT in detecting the presence or absence of lesions in the various anatomic regions, and the severity scores were the same in 90% of all cases (range, 75-100%). When different severity scoring was obtained, CT detected more lesions with a high severity score in the facial skeleton, pelvis, and extremities, whereas AU detected more lesions with high scores in the soft tissues (especially in the aorta), cranium, and ribs. The kappa value for reproducibility of AIS scores confirmed that the agreement between the two methods was good. The lowest kappa values (>0.6) were found for the facial skeleton, cerebellum, meninges, neck organs, lungs, kidneys, and gastrointestinal tract. In these areas, the kappa value provided moderate agreement between CT and AU. For all other areas, there was a substantial agreement between the two methods. The ISS scores obtained by CT and by AU were calculated and were found to be with no or moderate variation in 85%. Rupture of the aorta was often overlooked by CT, resulting in too low ISS scoring. DISCUSSION:: The most precise postmortem AIS and ISS scorings of traffic fatalities was obtained by a combination of AU and CT. If it is not possible to perform an AU, then CT may be used as an acceptable alternative for AIS scoring. We have identified one important obstacle for postmortem ISS scoring, namely that aorta ruptures are not easily detected by post mortem CT. Language: en

This is a prospective investigation of a consecutive series of 250 deceased individuals who were computerized tomography (CT)-scanned and autopsied. In 13% of patients, important findings at the CT-scanning were not found at the autopsy, and in 48% of patients, important autopsy findings were not found at the CT-scanning. The cause of death could be established by CT in 31%, by autopsy in 74%, and by toxicology in 22%. CT combined with data from the inquest could establish the cause of death in a majority of deaths due to severe trauma, but only in a minority of deaths caused by disease or poisoning. We found the Siemens Somatom Spirit dual-slice CT-scanner cost effective, quick, and well suited as a supplement to the routine autopsy. CT is useful in identifications, gunshot lesions, and traffic accidents. CT allows investigation of anatomic regions that are not easily available by autopsy and allows fractures and inner organs to be seen "in situ." CT provides documentation in digital form - easily stored - permits review by others and provides pictures that may be more suitable for presentation in court than autopsy photos.

Intimate partner homicides represent the most severe outcome of intimate partner violence, and constitute more than a quarter (26%) of all homicides in adults over 15 years of age in Southern Denmark. In our experience the victims of partner homicides are primarily women, often from socially disadvantaged families, and that these homicides usually are the result of an impulsive act, with the perpetrator often committing suicide after the act. The aim of this study was to investigate these hypotheses further, and to provide an up-to-date overview of intimate partner homicides in Southern Denmark.

In 4929 consecutive autopsies performed during a period of 4 years, 222 cases (4.5%) of cirrhosis were found, of which 149 (3%) were detected while the patients were alive (diagnosed cirrhosis) and 73 (1.5%) were not detected while the patients were living (undiagnosed cirrhosis). Fifty-three of the 73 undiagnosed patients appeared to be completely without signs of cirrhosis (silent cirrhosis). In the diagnosed group, 70% of patients died from hepatic causes, in contrast to 16% in the undiagnosed group. At autopsy, the following complications of cirrhosis were found more frequently in the diagnosed group than in the undiagnosed group: ascites (41% vs. 8%), oesophageal varices (44% vs. 10%), splenomegaly (52% vs. 29%). The prevalence of hepatocellular carcinoma did not differ significantly in the two groups (12% vs. 8%). It is concluded that cirrhosis without obvious signs occurs relatively frequently, and that no sensitive non-invasive screening methods are available at present.

UNLABELLED: A case of perinatally acquired spinal cord injury (SCI) is presented. The foetus was vigorous until birth, the breech presented and delivery was performed by a non-traumatic Caesarean section. The infant displayed symptoms of severe SCI but diagnosis was delayed due to severe co-morbidity. Diagnostic considerations are briefly reviewed. Ventilatory support was withdrawn at the age of 20 days when the infant had still not exhibited any respiratory effort or spontaneous movements. Autopsy revealed a serious congenital malalignment of the upper cervical vertebrae and at the histological examination extensive reactive changes were observed in the same area. To our knowledge such findings have not been published previously.CONCLUSION: In cases of serious perinatally acquired SCI, claim of malpractice is often apparent. In this case a hidden congenital malformation of the cervical vertebrae was revealed, highlighting the need of careful postmortem examinations in such cases.

Computerized tomography (CT) is finding increased use in forensic medicine. In this article we present our experience with CT in medico legal deaths.This is a retrospective investigation of 150 deceased individuals who were CT-scanned and autopsied. The CT-scanning was performed and interpreted by a specialist in forensic medicine. The CT-scanning and the autopsy were performed independently by two different physicians.In 9% of the cases, important findings by the CT-scanning were overlooked at the autopsy, and in 51% important findings by the autopsy were not found by the CT-scanning. The cause of death could be established by CT-scanning in 30%, by autopsy in 72% and by toxicology in 21% of the cases. CT-scanning was most useful in cases of traumatic death.CT is rarely a substitute for autopsy, but may contribute with important new information in many cases such as identifications (including mass-disasters), gunshot wounds and traffic accidents. CT provides documentation in digital form that is easily stored and copied, permits review by others and provides pictures that may be more suitable for presentation in court than autopsy photos. CT may be helpful in medico legal external examinations (inquests) in the process of selecting cases for autopsy.

Child homicides are rare but serious crimes. In this study the homicide rate and the development in the crime pattern will be investigated.The investigation is retrospective and comprises the 34 years during which the Institute of Forensic Medicine in Odense has existed. During this period 41 children under the age of 15 were killed in 30 episodes.The most frequent method of homicide was manual strangulation, and the second most frequent was blunt violence. It is demonstrated that the incidence of child homicide has decreased considerably compared to a previous investigation comprising all of Denmark. By far the largest decrease is in homicides committed by women against their own children, which have often been followed by suicide (family homicides). The decrease in family homicides committed by men is much less. Today men commit family homicides 8 times as frequently as women in the area under investigation.A possible explanation for the decreasing number of homicides committed by women against their own children is the decreased use of gas for cooking, whereby a frequent homicide method disappeared, and by improved socio-economic life conditions and gender balance. Men are now responsible for the majority of family homicides. Preventative measures for men in socially traumatic situations such as a divorce are recommended.

Fatal pulmonary thromboembolism is a relatively common autopsy finding. The aim of this investigation is to describe the magnitude of the problem in an autopsy material and factors of prophylactic importance and to discuss the importance of the autopsy.Deceased with lethal pulmonary thromboembolism diagnosed by forensic autopsy at the Department of Forensic Medicine at the University of Southern Denmark in 1992-2005, in total 58 individuals. Data were collected from autopsy- plus police reports and medical records.Descriptive case-only investigation.The pulmonary embolism had in none of the cases been diagnosed before death. Two of the individuals in this investigation were healthy young females who used oral contraceptives, and one was a psychiatric patient who died from pulmonary embolism after five days of physical restraint.The diagnosis is sometimes not made before the autopsy. The decreasing autopsy frequency may result in a lack of diagnosis of pulmonary embolism as cause of death.

Homicidal hanging is rare and presents special problems for the forensic pathologist. We report a case of homicide by hanging masquerading as suicide, in which the forensic evidence was of crucial importance. The victim was a 61 years old man, who was found in his house suspended by a rope around his neck. The autopsy showed fresh bruises due to blunt trauma. Moreover, a voluminous subdural haematoma with brain swelling was found which indicated that the victim was unconscious at the time of the hanging. An obvious vital reaction consisting of cutaneous bleeding in the ligature mark supported the opinion that the deceased was alive and not dead at the time of the hanging. The estimation of the time of death was of great importance, as only one other person could have been present at the estimated time interval. This person was later sentenced to prison for manslaughter.

The United Nations Convention against torture prohibits repatriation of refugees if there is reason to believe they will be tortured on return to their country. A history of torture is therefore an important factor in making a case for asylum. In this study, the results of the medical examinations of 59 torture victims investigated at the Department of Forensic Medicine, University of Aarhus, Denmark, 1996-2002, are presented and discussed. Variables including age, sex, education, health, torture methods, condition of confinement, torture aftereffects, and findings at the forensic examination were registered in a database (Paradox) and analyzed. In 70%, aftereffects of torture could be documented. These included scars after fixation, burns, incisions, or flogging. Symptoms and signs from joints, muscles, and nerves were common in victims who had been suspended. Many of the victims of phalanga had painful feet and signs of walking impairment. A majority of the victims suffered from posttraumatic stress syndrome. An independent medical report offers an opportunity to evaluate and elaborate the story told by the victim and should be used in disputed cases. We have a duty to protect refugees against torture.

Ethylene glycol (EG) can be found in many agents, such as antifreeze. Ingestion of EG may cause serious poisoning. Adults are typically exposed when EG is ingested as a cheap substitute for ethanol or in suicide-attempts. Children may be exposed by accidental ingestion caused by decantation of EG to unlabeled bottles. EG has in itself a low toxicity, but is in vivo broken down to four organic acids: glycoaldehyde, glycolic acid, glyoxylic acid and oxalic acid. The metabolites are cell toxins that cause central nervous system depression, and cardio-pulmonary and renal failure. Glycolic acid causes severe acidosis, and oxalate is precipitated as calcium oxalate in the kidneys and other tissues. We present five case reports of fatal EG-poisoning, and review the literature concerning clinical presentation and diagnosis, pathological findings, treatment and prevention.

Massive subarachnoid hemorrhage may occur on a traumatic basis. The injury is most often sustained by a blow with a clenched fist against the posterolateral part of the cranial basis, but the injury may also occur in relation to an accident. The condition is rare, most often occurring in alcohol intoxicated men. The victim typically collapses immediately and usually dies within a few minutes. The origin of the bleeding may be the vertebral artery on the neck or the intercranial basal brain arteries. In some cases the origin of the bleeding cannot be located. The pathogenetic mechanisms have been a subject of discussion. The damage to the artery may occur in relation to a fracture of the transverse process of the atlas or in relation to subluxations in the cervical vertebral column. The arterial rupture may occur in both normal and abnormal arteries. In many of the cases the trauma may be very slight. This has, of course, important legal implications.

Background . The death rate for fatal fire accidents in Denmark has doubled since 1951, mostly due to an increase in the number of fire accidents associated with smoking. The most common cause of residential fire deaths in Denmark today is smoking, often combined with alcohol intoxication or handicap. Methods . This was a case-control study of fatal fire accidents in private homes in the municipality of Copenhagen from 1991 to 1996. The fatal fire accidents were identified from a police register, and the two non-fatal fire accidents registered immediately before and after each fatal fire were selected as a control group. Information about the circumstances surrounding the fires was derived from the police reports. Multivariate logistic regression analysis was used to estimate the risk associated with each variable after adjusting for confounders. The analysis was performed on the basis of the theoretical model in which the variables were part of a causal network. Results . The following five variables seemed to be of most importance: (1) localization of the victim close to the source of ignition (OR = 11), (2) physical handicaps (OR = 5), (3) chronic alcoholism (OR = 7), (4) clothing fires (OR = 24), and (5) alarm being given by a person not present at the scene of fire (OR =33). Preventive measures are discussed in the light of the results.