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We investigated the infectivity of 128 severe acute respiratory disease coronavirus 2-associated deaths and evaluated predictive values of standard diagnostic procedures. Maintained infectivity (20%) did not correlate with viral RNA loads but correlated well with anti-S antibody levels. Sensitivity >90% for antigen-detecting rapid diagnostic tests supports their usefulness for assessment.

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce. To distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts. 84.1% (n = 618) were classified as COVID-19 deaths, 6.4% (n = 47) as non-COVID-19 deaths, 9.5% (n = 70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n = 283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n = 187). Thromboses were found in 39.2% (n = 62/158 cases), pulmonary embolism in 22.1% (n = 56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n = 618) represented COVID-19 deaths. Our study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.

Background Decedents who are repatriated to Germany from abroad are not systematically registered nationwide. In Hamburg, in addition to an epidemic hygienic examination, registration and examination of the content of the documents accompanying the corpses of German citizens has been carried out since 2007. In this way, unclear and non-natural deaths in particular are to be followed up as necessary. Material and methods Protocols of external and internal autopsies of German nationals who died abroad and were repatriated to Hamburg via the port or airport between 2007 and 2018 were retrospectively evaluated with respect to numbers, completeness of the autopsy abroad and correctness of manner and cause of death. Results Between 2007 and 2018 a total of 703 corpses were repatriated via the port or airport of Hamburg and examined by the Port Medical Service for epidemic hygiene and for anything conspicuous in the documents accompanying the corpse. Of them, 307 corpses were examined at the Institute of Legal Medicine at the University Medical Center Hamburg-Eppendorf. In total, 82.4% of the examined cases had an incorrect, unspecific or incomplete foreign death certificate. Of the deceased, 238 were subjected to a second external autopsy by a forensic pathologist and 69 deceased were autopsied again or for the first time in Hamburg. It was found that 84% of the autopsies performed abroad were not performed according to German and European standards. The most common discrepancy was incomplete preparation of the organs. In almost one quarter of the autopsies performed in Hamburg a different cause of death than abroad was determined at autopsy. Conclusion Since the quality of autopsies performed abroad sometimes does not meet the standards in Germany and Europe and many papers accompanying corpses are incomplete or incorrectly filled out, a systematic review procedure in the home country is recommended. Through the system established in Hamburg in 2007, at least a re-evaluation of the cases takes place.

Die Todesfeststellung ist eine alltagliche arztliche Aufgabe im Rettungsdienst und auch bei offensichtlichen Gewaltverbrechen, Unfallen oder Suiziden erforderlich. Das Rettungsteam muss die teilweise divergenten landesrechtlichen Bestimmungen zum Umgang mit Verstorbenen kennen und die Notarzt*in die Leichenschau und das Ausstellen der Todesbescheinigung sicher beherrschen. In dieser Arbeit werden die wesentlichen Aspekte zur Feststellung der Diagnose Tod, zur Durchfuhrung der Leichenschau und zum Ausstellen der Todesbescheinigung im ambulanten Bereich aus Sicht der Rechtsmedizin erlautert. Fur eine sachgerechte Bearbeitung werden praktische Tipps gegeben. Ein sicherer Umgang mit Leichenschau und Todesbescheinigung im Rettungsdienst ist Voraussetzung dafur, dass das offentliche Rechtsinteresse gewahrt und eine valide Todesursachenstatistik gefuhrt werden kann.

Zusammenfassung Hintergrund Im Rahmen der COVID-19-Pandemie sind Inzidenz und Mortalität entscheidende Determinanten, um Ausbreitungsdynamik und Gefahrenpotenzial zu beurteilen. Untersucht wird, ob ein systematisches mikrobiologisches Monitoring von Todesfällen eine relevante Untererfassung der Mortalität aufzeigen kann, und ob sich ggf. eine Sterbekohorte zuvor nicht erfasster Fälle von einer Hellfeldkohorte unterscheidet (Soziografie, Todesursache). Methode Es erfolgte eine systematische Reverse-Transkriptase(RT)-qPCR(quantitative Polymerasekettenreaktion)-Testung von Verstorbenen in zentralen Leichenhallen in Hamburg (Institut für Rechtsmedizin, Krematorium) auf eine SARS-CoV‑2-Infektion mittels Nasen-Rachen-Abstrich über 8 Wochen ab Auftreten pandemiebezogener Todesfälle mit vergleichender Analyse der Hell- und Dunkelfeldkollektive. Ergebnisse Unter insgesamt 1231 verdachtsunabhängig getesteten Verstorbenen lag bei 29 Fällen (2,4 %) eine zuvor nicht bekannte SARS-CoV‑2-Infektion vor. In der ersten Phase der Pandemie überwogen Zufallsentdeckungen unter unklaren und nichtnatürlichen Todesfällen in der Rechtsmedizin, die vermehrt jüngere Altersgruppen, v. a. aus häuslicher Umgebung, umfassten. Im Krematorium zeigten sich mit weiterem Verlauf zunehmend Zufallsentdeckungen bei Todesfällen aus stationären Pflegeinstitutionen. Das Gesamtkollektiv wies soziodemografisch keine signifikanten Unterschiede zu einem Vergleichskollektiv bekannter/registrierter SARS-CoV‑2-assoziierter Todesfälle auf. In der Dunkelfeldkohorte war die Todesursache COVID-19 signifikant seltener. Schlussfolgerung Ein systematisches verdachtsunabhängiges PCR-basiertes Monitoring von Todesfällen ermöglicht eine vollständigere Erfassung von SARS-CoV‑2-positiven Sterbefällen insbesondere im nichtklinischen Sektor. Durch die Erfassung eines Dunkelfelds, das einer Routineleichenschau bislang entgeht, kann ein präventiver epidemiologischer Beitrag geleistet werden.

Zusammenfassung Einleitung In der internationalen Literatur finden sich mehrere Auswertungen zu SARS-CoV-2-assoziierten Todesfällen bei Personen in hohem Lebensalter. Ziel dieser Arbeit war die Evaluation SARS-CoV-2-assoziierter Todesfälle von Personen jüngeren oder mittleren Lebensalters (bis 50 Jahre) im Institut für Rechtsmedizin in Hamburg mit Darstellung der Häufigkeit, der Komorbiditäten und der Krankheitsverläufe. Material und Methoden Durch das Institut für Rechtsmedizin in Hamburg wurden im Jahr 2020 insgesamt 735 SARS-CoV-2-assoziierte Fälle von Verstorbenen mit Hamburger Meldeadresse anhand verschiedener Untersuchungsmethoden evaluiert. Die Auswahl und Durchführung der jeweiligen Untersuchungsmethoden erfolgten je nach Zustimmung durch die nächsten Angehörigen. Darüber hinaus wurden weitere Sektionen von Verstorbenen mit externer Meldeadresse und positivem SARS-CoV-2-Nachweis durchgeführt. Ergebnisse und Schlussfolgerungen Neun der 735 Verstorbenen mit Hamburger Meldeadresse und 3 der untersuchten Todesfälle mit externer Meldeadresse (n = 12; 7 Männer und 5 Frauen) waren ≤50 Jahre alt, mit einem Altersdurchschnitt von 39,8 Jahren. Im Wesentlichen bestanden kardiovaskuläre, neurologische und maligne Erkrankungen sowie eine Adipositas. Bei 2 Todesfällen wurde SARS-CoV‑2 erstmalig postmortal nachgewiesen; bei diesen beiden fand sich eine virusunabhängige Todesursache. Sieben der Personen verstarben an einer COVID-19-Pneumonie, 3 Personen an den Folgen der notwendigen intensivmedizinischen Behandlung. Mehrere Studien konnten insbesondere bei jüngeren Patienten einen Zusammenhang zwischen Übergewichtigkeit und schweren SARS-CoV-2-bedingten Krankheitsverläufen zeigen, was sich auch im hiesigen rechtsmedizinischen Untersuchungskollektiv bestätigte.

Infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) results in respiratory syndromes but also in vascular complications such as thromboembolism (TE). In this regard, immunothrombosis, resulting from inflammation in SARS-CoV-2 infected tissues, has been described. Data on TE in COVID-19 are mainly based on clinical observational and/or incomplete autopsy studies. The true burden of TE and the relevance of genetic predisposition, however, have not been resolved.Here, we report on a consecutive cohort of 100 fully autopsied patients deceased by SARS-CoV-2 infections during the first wave of the pandemic (March to April 2020). We investigated the localization of TE, potential clinical risk factors, and the prothrombotic gene mutations, factor V Leiden and prothrombin G20210A, in postmortem blood or tissue samples.TE was found in 43/100 autopsies. 93 % of TE events were venous occlusions, with 23 patients having pulmonary thromboembolism (PT) with or without lower-extremity deep vein thrombosis. Of these, 70 % showed PT restricted to (sub)segmental arteries, consistent with in situ immunothrombosis. Patients with TE had a significantly higher BMI and died more frequently at an intensive care unit. Hereditary thrombophilia factors were not associated with TE.Our autopsy results show that a significant proportion of SARS-CoV-2 infected patients suffer from TE, affecting predominantly the venous system. Orthotopic peripheral PT was the most frequent finding. Hereditary thrombophilia appears not to be a determinant for TE in COVID-19. However, obesity and the need for intensive care increase the risk of TE in these patients.

ZUSAMMENFASSUNGBei der Erkrankung COVID-19 (coronavirus disease 2019) handelt es sich um eine virale Infektion mit einem Betacoronavirus, bei der die Infizierten an unterschiedlichen klinischen Symptomen leiden. Bei Erkrankten können sich Symptome wie Husten, Fieber sowie schwere respiratorische und organische Funktionseinschränkungen zeigen 1, 2. Pathophysiologisch bindet nach der Aufnahme des Virus über den oberen Respirationstrakt ein viruseigenes Spikeprotein an den membrangebundenen ACE2-Rezeptor (Angiotensin-converting enzyme 2 Rezeptor), welcher vorrangig in Lungen-, Herz- und Nierengewebe exprimiert wird. Da es bei den unterschiedlichen Organgeweben zu heterogenen Expressionsmustern von ACE2-Rezeptoren kommt, sind die Effekte der Infektion variabel. Diese pathologischen Veränderungen werden im Folgenden aus den Erkenntnissen bisheriger Publikationen, in denen postmortale Untersuchungen im Rahmen einer offenen Leichenschau (Obduktion) oder einer postmortalen Bildgebung (PMCT) durchgeführt wurden, zusammenfassend dargestellt. Nicht näher eingegangen wird auf die bereits vielfach dargestellten diversen Vorerkrankungen der meist multimorbiden und hochbetagten Patienten unter den COVID-19-Sterbefällen.

Background The new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused more than 210 000 deaths worldwide. However, little is known about the causes of death and the virus's pathologic features. Objective To validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virologic tests. Design Prospective cohort study. Setting Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction-confirmed diagnosis of COVID-19. Patients The first 12 consecutive COVID-19-positive deaths. Measurements Complete autopsy, including postmortem computed tomography and histopathologic and virologic analysis, was performed. Clinical data and medical course were evaluated. Results Median patient age was 73 years (range, 52 to 87 years), 75% of patients were male, and death occurred in the hospital (n = 10) or outpatient sector (n = 2). Coronary heart disease and asthma or chronic obstructive pulmonary disease were the most common comorbid conditions (50% and 25%, respectively). Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Postmortem computed tomography revealed reticular infiltration of the lungs with severe bilateral, dense consolidation, whereas histomorphologically diffuse alveolar damage was seen in 8 patients. In all patients, SARS-CoV-2 RNA was detected in the lung at high concentrations; viremia in 6 of 10 and 5 of 12 patients demonstrated high viral RNA titers in the liver, kidney, or heart. Limitation Limited sample size. Conclusion The high incidence of thromboembolic events suggests an important role of COVID-19-induced coagulopathy. Further studies are needed to investigate the molecular mechanism and overall clinical incidence of COVID-19-related death, as well as possible therapeutic interventions to reduce it. Primary funding source University Medical Center Hamburg-Eppendorf.

Die durch das neue Coronavirus (SARS-CoV-2) bedingte Erkrankung Coronavirus-Krankheit 2019 (COVID-19) stellt eine Gefahrdung fur Altere dar. Ende Marz 2020 kam es zu einem ersten, bislang grosten Infektionsausbruch in einem Seniorenpflegewohnheim in Hamburg. Analyse von Verfahrensablaufen in einer von SARS-Coronavirus-2 (SARS-CoV‑2) betroffenen Wohneinheit mit 60 demenziell vorerkrankten Senioren sowie umfassende Darstellung der Obduktionsbefunde SARS-CoV-2-positiv getesteter dortiger Sterbefalle. In 39 von 60 Fallen infizierten sich Pflegeheimbewohner mit SARS-CoV‑2. Eine Ausbreitung der Infektionswelle auf andere Wohnbereiche lies sich verhindern. In allen 8 Sterbefallen wurde durch die Obduktion die Diagnose eines COVID-19-bedingten Todes gestellt. Autoptisch fanden sich eine todesursachliche (Broncho‑)Pneumonie sowie Korrelate relevanter kardialer, renaler und pulmonaler Vorerkrankungen in allen Fallen. In 75 % (n = 6) der Falle waren frische Unterschenkelvenenthrombosen, in 66,7 % (n = 4) kombiniert mit peripheren Lungenarterienthromboembolien, nachweisbar. Das im deutschsprachigen Raum erstmals systematisch beschriebene Kollektiv von SARS-CoV-2-Infizierten in einer Pflegeeinrichtung ist charakteristisch fur die bislang bekannten klinischen und epidemiologischen Besonderheiten der neuen Coronainfektion. Durch die zentralisierte Evaluation aller Todesfalle in Hamburg war eine gezielte Aufarbeitung der SARS-CoV-2-positiven Sterbefalle unter den betroffenen Heimbewohnern moglich. Der deutlich erhohten Letalitat von ca. 20 % konnten in allen Fallen relevante Komorbiditaten multipler Organsysteme zugeordnet werden – die mit den klinischen Daten im Einklang standen.

Blood at crime scenes is one of the most significant traces of evidence in investigation proceedings. Cleaning up these traces with household cleaning products, often containing bleaching agents, inhibits or complicates the detection of DNA. In this study, human blood was applied onto different floor coverings (carpet, laminate, parquet, PVC, tile) and subsequently cleaned with water and bleaching agents (hydrogen peroxide, sodium hypochlorite, DanKlorix®, Vanish Oxi Action®) at different times. Samples have been collected afterwards from the floors. The samples underwent a quantitative and qualitative DNA analysis. Cleaning smooth surfaces with water is usually sufficed to prohibit retrieving a DNA profile in most of the cases. Cleaning carpets was more difficult due to their absorbent surface whereas the use of bleaching agents caused an additional reduction of verifiable DNA concentrations. Retrieving partial or complete profiles after the use of bleaching agents was only possible when cleaning with low concentrations of 3% hydrogen peroxide.

Purpose Injury-related asphyxia is one of the most common causes of death in children in Germany. However, only a few systematic studies have analyzed the causes and circumstances of asphyxia in children and adolescents. Methods All cases of asphyxia in children and adolescents (0–21 years of age) among the Hamburg Legal Medical Department’s autopsy cases from 1998 to 2017 were retrospectively analyzed with special focus on how often external findings were completely absent. Results Among 249 cases of fatal asphyxia, 68% were accidents, 14% were suicides, and 13% were homicides. Most of the cases involved boys. Adolescents and young adults aged 15–21 years represented the main age group. Drowning was the leading mechanism of asphyxia. Younger age was associated with less frequent detection of external signs of asphyxia in the postmortem external examination. Petechial hemorrhages were the most common visible external indication of asphyxia. No external findings indicative of asphyxia were present in 14% of the cases. Conclusion Asphyxia in children and adolescents often involves accidents. However, postmortem external examination alone is insufficient to identify asphyxia and the manner of death.

The lancet / Regional health. Europe 15, 100330 (2022). doi:10.1016/j.lanepe.2022.100330, Published by Elsevier, [Amsterdam]

Post-mortem computed tomography (PMCT) is a rapid and noninvasive diagnostic tool for important contributions to the identification of pulmonary findings in the deceased with pneumonia, including cases of coronavirus disease 2019 (COVID-19). Although computed tomography (CT) shows a high sensitivity for pneumonia in living persons, it is relatively unspecific for COVID-19 pneumonia clinically. Typical CT findings for viral pneumonia therefore require confirmation by PCR tests (polymerase chain reaction tests), even if lung infections with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) show characteristic patterns, most frequently ground glass opacities (GGO) and a combination of GGO and air space consolidations. In the consecutive autopsy series of SARS-CoV‑2 deaths from Hamburg, Germany, the most frequent cause of death was and still is COVID-19 pneumonia. Typical findings were frequently found in the PMCT in SARS-CoV-2-associated deaths, which were taken into account when classifying the death as COVID-19.Die Post-mortem-Computertomographie (PMCT) ist ein schnelles und nicht-invasives Diagnoseinstrument, das einen wichtigen Beitrag zur Identifizierung von Lungenbefunden bei Verstorbenen mit Pneumonie leistet – auch bei Fällen der Coronaviruskrankheit (COVID -19). Obwohl die Computertomografie (CT) eine hohe Sensitivität für Lungenentzündungen bei lebenden Personen aufweist, ist sie für eine COVID-19-Pneumonie klinisch recht unspezifisch. Typische CT-Befunde für virale Pneumonien bedürfen daher der Bestätigung durch PCR-Tests (Polymerase-Ketten-Reaktion-Tests), auch wenn die Lungeninfektion mit SARS-CoV‑2 charakteristische Muster zeigt – am häufigsten Milchglastrübungen (GGO) und eine Kombination aus GGO und Konsolidierungen.In der konsekutiven Autopsieserie von SARS-CoV-2-Todesfällen aus Hamburg war und ist die häufigste Todesursache die COVID-19-Pneumonie. In der PMCT fanden sich bei SARS-CoV-2-assoziierten Todesfällen häufig typische Befunde, die bei der Klassifizierung des Todes als COVID-19 berücksichtigt wurden.

Traumatic brain injury (TBI) is a major cause of death and its accurate diagnosis is an important concern of daily forensic practice. However, it can be challenging to diagnose TBI in cases where macroscopic signs of the traumatic head impact are lacking and little is known about the circumstances of death. In recent years, several post-mortem studies investigated the possible use of biomarkers for providing objective evidence for TBIs as the cause of death or to estimate the survival time and time since death of the deceased. This work systematically reviewed the available scientific literature on TBI-related biomarkers to be used for forensic purposes. Post-mortem TBI-related biomarkers are an emerging and promising resource to provide objective evidence for cause of death determinations as well as survival time and potentially even time since death estimations. This literature review of forensically used TBI-biomarkers revealed that current markers have low specificity for TBIs and only provide limited information with regards to survival time estimations and time since death estimations. Overall, TBI fatality-related biomarkers are largely unexplored in compartments that are easily accessible during autopsies such as urine and vitreous humor. Future research on forensic biomarkers requires a strict distinction of TBI fatalities from control groups, sufficient sample sizes, combinations of currently established biomarkers, and novel approaches such as metabolomics and mi-RNAs.

Virchows Archiv 480(3), 519-528 (2022). doi:10.1007/s00428-021-03263-7, Published by Springer, Berlin ; Heidelberg

BackgroundCoronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce.MethodsTo distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts.Findings84.1% (n=618) were classified as COVID-19 deaths, 6.4% (n=47) as non-COVID-19 deaths, 9.5% (n=70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n=283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n=187). Thromboses were found in 39.2% (n=62/158 cases), pulmonary embolism in 22.1% (n=56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n=618) represented COVID-19 deaths.InterpretationOur study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.

Die Feuerbestattung ist in Deutschland die fuhrende Bestattungsform. Durch die Einascherung geht der Leichnam als Beweismittel verloren. In fast allen Bundeslandern ist eine zweite Leichenschau vor der Feuerbestattung (Krematoriumsleichenschau) gesetzlich vorgeschrieben. Haufig wird die zweite Leichenschau von einem Rechtsmediziner durchgefuhrt. In diesem Beitrag wird eine Ubersicht unterschiedlicher, uberwiegend rechtsmedizinischer Auswertungen zur Krematoriumsleichenschau gegeben sowie von eigenen Erfahrungen in der Krematoriumsleichenschau berichtet. Durch den zweiten Leichenschauer werden regelmasig formale und inhaltliche, teilweise gravierende Fehler in der Todesbescheinigung festgestellt. Ergeben sich Hinweise auf einen nichtnaturlichen Tod oder Zweifel an der Identitat des Leichnams, wird dieser vom zweiten Leichenschauer vorerst nicht zur Feuerbestattung freigegeben, er wird „angehalten“ und ggf. an die zustandige Ermittlungsbehorde gemeldet. Hinweise auf korperliche Traumata und arztliche Behandlungsfehler sind die haufigsten Anhaltegrunde bei der Krematoriumsleichenschau. Die Anhaltequote bei der zweiten Leichenschau ist niedrig (bis etwa 5 %). Etwa 0,5–2 % der Todesfalle werden von dem zweiten Leichenschauer an die Ermittlungsbehorden gemeldet. Die Anzahl der gerichtlichen Obduktionsanordnungen von Verstorbenen, die bei der Krematoriumsleichenschau als auffallig gemeldet worden sind, ist regelmasig niedrig (bei etwa 1 %). Derzeit ist die Krematoriumsleichenschau durch einen spezialisierten Leichenschauer weiterhin ein erforderliches Instrument zum Erkennen von nichtnaturlichen Todesfallen. Eine relevante Verbesserung der Todesursachenstatistik konnte durch eine hohere Quote von nachfolgenden Obduktionsanordnungen erreicht werden.

The quality of external post-mortem examinations and medical death certificates has long been criticized and autopsy rates are on the decline. To identify potential errors in external post-mortem examinations and hospital death certificates, this study examined the quality of information provided regarding both aspects at the University Medical Center Hamburg-Eppendorf (UKE). Among the 630 patients who died at the UKE during a period of 5 months in 2017, the post-mortem findings and death certificates of 511 were re-examined. Furthermore, for 419 deceased patients where a forensic autopsy was carried out at the UKE from 2008 to 2016, the clinical data were compared with the autopsy results. For 77 (15%) of the decedents, the second external post-mortem examination produced relevant findings that had not been previously reported on the death certificates. This included information regarding relevant medical interventions (9%), significant disorders (5%), and trauma (2%). Formal errors were rarely found on the death certificates. In 62% the cause of death and underlying disorders stated in the death certificates were in full agreement with the diagnoses identified at autopsy. Nonconformities were identified in 10%. The quality of external post-mortem examinations and medical death certificates should be improved. It is evident that autopsies are indispensable for verifying the cause of death.

Introduction Different methods are used to confiscate evidence whenever suspected body packers or body stuffers are taken into custody. Among these, controlled defecation and analysis of drug toilets from suspects has proved to be safe given that no invasive or forceful procedures are applied. Materials and methods All records of “drug toilet” evaluations done at the Hamburg Institute of Legal Medicine from January 1st 2018 to April 30th 2021 were descriptively analyzed for the individual’s age, sex, country of origin, and whether the drug toilets contained any drug “balls”, packages or containers. In case of a positive finding, the total number of balls found were recorded. Special cases are presented in detail for illustrative purposes. Results Drug toilets from 72 suspects were examined in the period under review. 98.6% (n = 71) of the suspects were males and relatively young with approximately two-thirds (62.5%, n = 45) aged 34 years or below (range 18–50 years). The majority of suspects originated from African countries (72.2%, n = 52). The typical drug balls or containers were found in 13 (18.1%) of the examined drug toilets. Conclusion Negative drug toilets might indeed indicate that the suspect had not ingested any drug packages at the time of arrest or while in custody. However, multiple excretions, voluntary delay of defecation, use of drugs to delay the excretion process or even individual differences in excretion times are possible, and therefore, a negative drug toilet should not always imply with certainty that the individual in question had not ingested any drugs.

The body of a deceased with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is considered infectious. In this study, we present the results of infectivity testing of the body and testing of mortuary staff for SARS-CoV-2. We performed real-time quantitative polymerase chain reaction (RT-qPCR) for SARS-CoV-2 on 33 decedents with ante mortem confirmed SARS-CoV-2 infection. Swabs of the body surface from five different body regions and from the body bag or coffin were examined. A subset of the swabs was brought into cell culture. In addition, screening of 25 Institute of Legal Medicine (ILM) personnel for ongoing or past SARS-CoV-2 infection was performed at two different time points during the pandemic. Swabs from all locations of the body surface and the body environment were negative in cases of negative post mortem nasopharyngeal testing (n=9). When the post mortem nasopharyngeal swab tested positive (n=24), between 0 and 5 of the body surface swabs were also positive, primarily the perioral region. In six of the cases, the body bag also yielded a positive result. The longest postmortem interval with positive SARS-CoV-2 RT-qPCR at the body surface was nine days. In no case viable SARS-CoV-2 was found on the skin of the bodies or the body bags. One employee (autopsy technician) had possible occupational infection with SARS-CoV-2; all other employees were tested negative for SARS-CoV-2 RNA or antibody twice. Our data indicate that with adequate management of general safety precautions, transmission of SARS-CoV-2 through autopsies and handling of bodies is unlikely.

Summary Background Prominent clinical symptoms of COVID-19 include CNS manifestations. However, it is unclear whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, gains access to the CNS and whether it causes neuropathological changes. We investigated the brain tissue of patients who died from COVID-19 for glial responses, inflammatory changes, and the presence of SARS-CoV-2 in the CNS. Methods In this post-mortem case series, we investigated the neuropathological features in the brains of patients who died between March 13 and April 24, 2020, in Hamburg, Germany. Inclusion criteria comprised a positive test for SARS-CoV-2 by quantitative RT-PCR (qRT-PCR) and availability of adequate samples. We did a neuropathological workup including histological staining and immunohistochemical staining for activated astrocytes, activated microglia, and cytotoxic T lymphocytes in the olfactory bulb, basal ganglia, brainstem, and cerebellum. Additionally, we investigated the presence and localisation of SARS-CoV-2 by qRT-PCR and by immunohistochemistry in selected patients and brain regions. Findings 43 patients were included in our study. Patients died in hospitals, nursing homes, or at home, and were aged between 51 years and 94 years (median 76 years [IQR 70–86]). We detected fresh territorial ischaemic lesions in six (14%) patients. 37 (86%) patients had astrogliosis in all assessed regions. Activation of microglia and infiltration by cytotoxic T lymphocytes was most pronounced in the brainstem and cerebellum, and meningeal cytotoxic T lymphocyte infiltration was seen in 34 (79%) patients. SARS-CoV-2 could be detected in the brains of 21 (53%) of 40 examined patients, with SARS-CoV-2 viral proteins found in cranial nerves originating from the lower brainstem and in isolated cells of the brainstem. The presence of SARS-CoV-2 in the CNS was not associated with the severity of neuropathological changes. Interpretation In general, neuropathological changes in patients with COVID-19 seem to be mild, with pronounced neuroinflammatory changes in the brainstem being the most common finding. There was no evidence for CNS damage directly caused by SARS-CoV-2. The generalisability of these findings needs to be validated in future studies as the number of cases and availability of clinical data were low and no age-matched and sex-matched controls were included. Funding German Research Foundation, Federal State of Hamburg, EU (eRARE), German Center for Infection Research (DZIF).

Autopsies of deceased with a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can provide important insights into the novel disease and its course. Furthermore, autopsies are essential for the correct statistical recording of the coronavirus disease 2019 (COVID-19) deaths. In the northern German Federal State of Hamburg, all deaths of Hamburg citizens with ante- or postmortem PCR-confirmed SARS-CoV-2 infection have been autopsied since the outbreak of the pandemic in Germany. Our evaluation provides a systematic overview of the first 80 consecutive full autopsies. A proposal for the categorisation of deaths with SARS-CoV-2 infection is presented (category 1: definite COVID-19 death; category 2: probable COVID-19 death; category 3: possible COVID-19 death with an equal alternative cause of death; category 4: SARS-CoV-2 detection with cause of death not associated to COVID-19). In six cases, SARS-CoV-2 infection was diagnosed postmortem by a positive PCR test in a nasopharyngeal or lung tissue swab. In the other 74 cases, SARS-CoV-2 infection had already been known antemortem. The deceased were aged between 52 and 96 years (average 79.2 years, median 82.4 years). In the study cohort, 34 deceased were female (38%) and 46 male (62%). Overall, 38% of the deceased were overweight or obese. All deceased, except for two women, in whom no significant pre-existing conditions were found autoptically, had relevant comorbidities (in descending order of frequency): (1) diseases of the cardiovascular system, (2) lung diseases, (3) central nervous system diseases, (4) kidney diseases, and (5) diabetes mellitus. A total of 76 cases (95%) were classified as COVID-19 deaths, corresponding to categories 1–3. Four deaths (5%) were defined as non-COVID-19 deaths with virus-independent causes of death. In eight cases, pneumonia was combined with a fulminant pulmonary artery embolism. Peripheral pulmonary artery embolisms were found in nine other cases. Overall, deep vein thrombosis has been found in 40% of the cases. This study provides the largest overview of autopsies of SARS-CoV-2-infected patients presented so far.

Autopsies of deceased with a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can provide important insights into the novel disease and its course. Furthermore, autopsies are essential for the correct statistical recording of the coronavirus disease 2019 (COVID-19) deaths. In the northern German Federal State of Hamburg, all deaths of Hamburg citizens with ante- or postmortem PCR-confirmed SARS-CoV-2 infection have been autopsied since the outbreak of the pandemic in Germany. Our evaluation provides a systematic overview of the first 80 consecutive full autopsies. A proposal for the categorisation of deaths with SARS-CoV-2 infection is presented (category 1: definite COVID-19 death; category 2: probable COVID-19 death; category 3: possible COVID-19 death with an equal alternative cause of death; category 4: SARS-CoV-2 detection with cause of death not associated to COVID-19). In six cases, SARS-CoV-2 infection was diagnosed postmortem by a positive PCR test in a nasopharyngeal or lung tissue swab. In the other 74 cases, SARS-CoV-2 infection had already been known antemortem. The deceased were aged between 52 and 96 years (average 79.2 years, median 82.4 years). In the study cohort, 34 deceased were female (38%) and 46 male (62%). Overall, 38% of the deceased were overweight or obese. All deceased, except for two women, in whom no significant pre-existing conditions were found autoptically, had relevant comorbidities (in descending order of frequency): (1) diseases of the cardiovascular system, (2) lung diseases, (3) central nervous system diseases, (4) kidney diseases, and (5) diabetes mellitus. A total of 76 cases (95%) were classified as COVID-19 deaths, corresponding to categories 1-3. Four deaths (5%) were defined as non-COVID-19 deaths with virus-independent causes of death. In eight cases, pneumonia was combined with a fulminant pulmonary artery embolism. Peripheral pulmonary artery embolisms were found in nine other cases. Overall, deep vein thrombosis has been found in 40% of the cases. This study provides the largest overview of autopsies of SARS-CoV-2-infected patients presented so far.

Multiorgan and Renal Tropism of SARS-CoV-2 In this autopsy series, the authors found that SARS-CoV-2 has an organotropism beyond the respiratory tract, including the kidneys, heart, liver, and brai...

Introduction Autoerotic deaths are rare events. The death scene is often bizarre and the death unexpected, thus often requiring forensic autopsies. Our analysis will provide an overview of the expected range of causes and manners of death in cases of autoerotic deaths. Methods A retrospective analysis was carried out on all scientific and forensic autopsies and postmortem examinations performed at the Department of Legal Medicine in Hamburg, Germany, over the period of 2004–2018. Results 25 cases of autoerotic fatalities were identified over this 15-year-period or one to two cases per year, respectively. Autopsies were carried out on 23 of these cases. 16 (64%) of the cases involved autoerotic accidents and 7 (28%) from internal causes of death during an autoerotic act. Two cases had not undergone an autopsy. On average, those who were involved in autoerotic accidents had been younger in age (average age: 37 years) than the individuals who died from internal disease (average age: 61 years). Only one woman was involved. The most common cause of death in autoerotic accidents was strangulation (hanging: 8 cases, ligature strangulation: 1 case), followed by smothering of the respiratory tract (4 cases). Fatal intoxication was diagnosed in three of the cases. Fatalities with natural cause of death solely involved cardiovascular causes of death. Conclusions Autoerotic deaths involved a wide range of natural and non-natural causes of death. The reconstruction of such unusual cases and detection of non-natural fatalities requires thorough investigation of the scene of death as well as a postmortem external and internal examination including a chemical toxicological and blood alcohol analysis.

In Hamburg, Germany, the initiation of HIV post-exposure prophylaxis (HIV PEP) in cases of sexual violence is often carried out by forensic medical specialists (FMS) using the city's unique Hamburg Model. FMS-provided three-day HIV PEP starter packs include a combination of raltegravir and emtricitabine/tenofovir. This study aimed to investigate the practice of offering HIV PEP, reasons for discontinuing treatment, patient compliance, and whether or not potential perpetrators were tested for HIV. We conducted a retrospective study of forensic clinical examinations carried out by the Hamburg Department of Legal Medicine following incidents of sexual violence from 2009 to 2016. One thousand two hundred eighteen incidents of sexual violence were reviewed. In 18% of these cases, HIV PEP was initially prescribed by the FMS. HIV PEP indication depended on the examination occurring within 24 h after the incident, no/unknown condom use, the occurrence of ejaculation, the presence of any injury, and the perpetrator being from population at high risk for HIV. Half of the HIV PEP recipients returned for a reevaluation of the HIV PEP indication by an infectious disease specialist, and just 16% completed the full month of treatment. Only 131 potential perpetrators were tested for HIV, with one found to be HIV positive. No HIV seroconversion was registered among the study sample. Provision of HIV PEP by an FMS after sexual assault ensures appropriate and prompt care for victims. However, patient compliance and completion rates are low. HIV testing of perpetrators must be carried out much more rigorously.

Hautzeichen bei akuter hamorrhagischer und nekrotisierender Pankreatitis wie das Cullen-, das Grey-Turner- oder das Fox-Zeichen (benannt nach den Erstbeschreibern) werden klinisch selten beobachtet. Die Pankreatitis ist aber nicht die einzige innere Ursache der Hauterscheinungen, die auch bei diversen anderen intraabdominellen Prozessen gefunden werden. In dieser Ubersicht werden die verschiedenen Hautzeichen vorgestellt und im Hinblick auf ihre Entstehung rekapituliert. Ziel der Studie war es, anhand von Autopsiefallen zu uberprufen, ob und wie haufig die Hautzeichen bei akuter Pankreatitis vorkommen. Nicht immer gelingt eine Abgrenzung der Hautzeichen aus innerer Ursache zu Hamatomen als Folge stumpfer Gewalteinwirkung oder nach medizinischer Nadelpunktion zweifelsfrei.

Vascular air embolism is caused by penetration of air into veins or arteries through a surgical wound or other connection between the external and internal aspects of the body. Vascular air embolism has various causes, and iatrogenic air embolisms are the most frequently described. We report a case of fatal air embolism in an 83-year-old woman who was admitted to hospital. At the time of the incident, she was alone in her ward receiving an intravenous infusion of antibiotics via a peripheral line in her right forearm. She was also inhaling air through a mask, which was connected via a tubing system to a compressed air connection in the wall behind her bed. Autopsy and postmortem computed tomography (PMCT) findings are presented. The case illustrates the high diagnostic value of PMCT, which is an effective procedure for detecting the presence of air or gas.

Since 27th December 2020, a mRNA vaccine from BioNTech / Pfizer (Comirnaty®) has been used across Germany. As of 12th March 2021, 286 fatalities of vaccinated German individuals were registered at the Paul-Ehrlich-Institute with time intervals after vaccination between one hour to 40 days. From our catchment area in northern Germany, we have so far become aware of 22 deaths in connection with vaccination in a 5 week period (range: 0–28 days after vaccination). Three death cases after vaccination with Comirnaty®, which were autopsied at the Institute of Legal Medicine Hamburg, are presented in more detail. All three deceased had severe cardiovascular diseases, among other comorbidities, and died in the context of these pre-existing conditions, while one case developed a COVID-19 pneumonia as cause of death. Taking into account the results of the postmortem examination a causal relation between the vaccination and the death was not established in any case. If there are indications of an allergic reaction, histological and postmortem laboratory examinations should be performed subsequent to the autopsy (tryptase, total IgE, CRP, interleukin-6, complement activity C3/C5).

In several countries, general practitioners conduct post-mortem external examination (PMEE) and certify death in out-of-hospital cases. A possible lack of accuracy has been repeatedly criticised, although data on everyday practice of PMEE on outpatients are scarce. To evaluate medical practitioner’s competence, education and accuracy regarding PMEE, we conducted a fax-survey among 1343 medical doctors in the metropolitan area of Hamburg, Germany. The results indicate considerable shortcomings in up to 63% regarding the inspection of body orifices and hidden areas, palpation of osseous structures, ectropionisation of the eyelids and use of aids. More than 5% of respondents reported to fill in a death certificate without performing a complete PMEE in the majority of cases. While theoretical teaching on PMEE was reported quite frequently (up to 78%), a considerably smaller group received practical training (32% during undergraduate and 13% during postgraduate education). To estimate the effects of training on PMEE, an individual “accuracy score” was calculated (range 1–5). Mean score was 3.63 (SD 0.81), and results differed significantly (p

Cremation is the most common type of burial in Germany. Evidence is lost when cremating the body. A second postmortem external examination (postmortem external examination at the crematory) is required by law in almost all German federal states prior to cremation. This duty is often performed by a legal medical specialist.This article provides an overview of different, mostly legal, medical assessments of the postmortem examination at the crematory and reports on personal experience in postmortem external examinations at crematories.The second postmortem medical examiner detects formal, content-related, and in some cases serious errors on medical death certificates on a regular basis. In cases with indications for a non-natural death or uncertain identity of the body, the cremation is stopped and some cases are reported to the investigative authority. Indications of death caused by physical trauma or malpractice are the most common reasons for delaying a cremation during the postmortem medical examination at the crematory. The percentage of delayed cremations is minimal (up to 5%). The second postmortem examiner reports approximately 0.5-2% of cases to the investigating authorities. The number of court-ordered autopsies of decedents that had been reported as being conspicuous has always been low (approximately 1%).Currently, the postmortem external examination by a specialist postmortem medical examiner at the crematory remains a vital prerequisite for identifying non-natural cases of death. Only a high number of autopsy orders can significantly improve the cause-of-death statistics of the postmortem external examinations at the crematory.

Cases of corpse dismemberment are rare, but occur most frequently in urban agglomerations. A distinction is made between defensive and offensive corpse dismemberment. This systematic review retrospectively assesses the phenomenology of 51 cases of corpse dismemberment (30 defensive and 21 offensive), which occurred in a period of 57 years and were subject to medico-legal autopsies performed at the Departement of Legal Medicine in Hamburg, Germany. The victims’ gender ratio was 1.7:1 female to male. In most cases, the perpetrators were middle-aged men from the close social environment, who had no psychiatric primary illnesses, no experience in the medical sector, and had not worked professionally as a butcher. In 80% of the cases it was possible to establish the cause of death; the most frequent cause was injuries sustained through sharp force (15 cases). The cases are discussed within the context of the existing international literature on corpse dismemberment.

Statistisch gesehen werden in Notaufnahmen deutscher Krankenhauser jeden Tag korperlich misshandelte Kinder arztlich untersucht. Wenn der Verdacht auf Kindesmisshandlung aufkommt, ist dies fur alle Beteiligten belastend. Sowohl eine tatsachlich vorliegende Kindesmisshandlung als auch die Fehldiagnose einer Misshandlung konnen fur die Kinder und ihre Familien sowie fur die Beschuldigten schwerwiegende Folgen haben. Eine sorgfaltige Anamnese, Untersuchung und genaue Dokumentation von Verletzungen sowie die Einleitung von Diagnostik helfen den Betroffenen genauso wie geeignete Schutzmasnahmen fur das Kind und ggf. weitere Betroffene (Geschwister) und Inanspruchnahme von Beratungsangeboten. Die Schweigepflicht kann und sollte ggf. gebrochen werden.

Introduction Repatriated corpses may have been autopsied abroad. The aim of the study was to compare the findings from second medico-legal autopsies with those from primary autopsies abroad to spotlight possible implications for the management of repatriated corpses. Material and Methods All autopsies from a 20-year period at the Institute of Legal Medicine in Frankfurt am Main on repatriated corpses of German citizens were reviewed. The results were compared with the information from the body passports, the protocols of the autopsies in the country of death, and the police files. Results In total, 151 corpses repatriated from 56 different countries were autopsied. The interval between death and autopsy in Germany was 2–603 days (median: 11 days). 91 of the repatriated corpses (59.5%) had previously been autopsied abroad. Three body cavities had been opened in 78.0% (71/91) of the original autopsies; among them, there were 11 cases (15.5%) with dissection of all organs, as opposed to 7 cases (9.9%) with all organs intact and in situ. Of the previously autopsied corpses, 62.6% were accompanied by a body passport that noted the cause of death. In nearly 75% of these cases, the stated cause of death was compatible with that established at second autopsy. In 5 cases (10.2%), the cause of death established in the second autopsy disagreed with that on the body passport. The most prominent disparity was a cranial gunshot wound rather than the stated fatal fall. Discussion This analysis of individual cases spotlights the problematics of an uncritical approval of the body passport. In light of the different procedural autopsy standards around the world, the validity of an autopsy abroad is discussed in the context of the second autopsy results. Conclusion A second external postmortem examination by qualified medical practitioners should be obligatory in all cases of repatriated corpses, with notification of the criminal police in all cases of non-natural or undetermined death. A timely second autopsy is recommended even in cases with previous autopsy abroad.

Background The postmortem external examination has repeatedly been the subject of political and medicolegal disputes. This study was performed to examine whether the postmortem external examination at the crematory provides additional benefits and to determine whether any differences in the quality of medical death certificates exist between hospital and non-hospital postmortem external examinations. Material and methods All cases of death that had been examined within the context of a second postmortem external examination at crematories performed by medicolegal specialists from the Hamburg Department of Legal Medicine were analyzed during a 6-month investigation period. Results A second postmortem external examination was carried out on 9981 decedents prior to cremation during the investigation period. In the interim, the second postmortem medical examiner did not release 474 bodies (4.7%) for cremation. Suspicion of death caused by trauma was the most frequent cause for delaying the release of the body. The quality of information stated on the medical death certificate was good in 112 certificates issued by clinicians (48.9%, n = 229) and in 51 issued by general practitioners (31.3%, n = 163). Discussion This study verified deficiencies in the initial postmortem external examination. A postmortem external examination prior to cremation by a medical professional specialized in this field is currently an indispensable component for quality assurance.

The bacterium Haemophilus influenzae type b (Hib) can cause severe and life-threatening infections such as epiglottitis and meningitis. The course of the disease can be very rapid, resulting in sudden death. The incidence of Hib-induced epiglottitis in children has declined since the introduction of vaccinations in countries where such vaccinations are routinely administered. We herein present a case involving a 2.5-year-old boy who died suddenly at home. He had developed acute-onset throat and abdominal pain and a high fever. Despite an emergency cricothyrotomy due to a complicated intubation because of a massively swollen epiglottis, the efforts to resuscitate the child were unsuccessful. He was a previously healthy toddler, but he had not yet been vaccinated. Microbiologic analysis revealed the pathogenic bacterium Hib. The main autopsy finding was acute epiglottitis with swelling and cherry-red coloring of the epiglottis. Postmortem cultures of the cerebrospinal fluid and heart blood also revealed Hib as the pathogenic agent. Acute pneumonia was also diagnosed microscopically. The present report describes a rare case of Hib-induced acute epiglottitis and presents the key findings of forensic investigations in this type of disease.

The cause-of-death-statistics and the release of the body for burial depend primarily on the information contained in the death certificate. How to handle the death certificate has been critically discussed in professional circles again and again. A retrospective review of 1,315 deaths from six acute care hospitals in Germany was carried out with regard to the quality of the death certificates, taking into account information contained in the medical records. The review covered the readability of the death certificate, the quality of the epicrisis, misclassifications relating to the manner of death and the degree of certainty regarding the cause of death. In 93 % of cases (n= 1,221), death certificates were clearly legible. In about half the cases (43.3 %, n=569), the quality of the entries in the "epicrisis" section was good. In 45 % of cases (n= 592), no details were provided in the "epicrisis " section. In 3.9 % (n = 42) of deaths classified as natural, information was given indicating a non-natural death. Most of these deaths occurred in connection with a fall or an injury (n = 27) or possible errors relating to treatment or care (n = 7). Overall, the review showed that clinicians handled the medical death certificate in a competent and careful manner. However, based on the content of the files, the review identified individual and avoidable misclassifications as to the manner of death and improbable causes of death; it also demonstrated that information on the epicrisis is often missing and needs significant improvement.

Ecstasy (MDMA) is a mood-lifting drug with numerous somatic side effects, for example, dehydration or continuous chewing and biting. We describe the case of a young woman who underwent a forensic medical examination for suspected sexual assault. She claimed to have suffered from a memory lapse, and she had a painful swelling of her lips with a plaque-like coating on her lips and buccal mucosa. The attending physician suspected that these findings might have been caused by strong sucking pressure on her lips within the context of a sexual assault. A toxicological examination of a blood specimen verified that she had been under the influence of an extremely high dose of ecstasy (1.456 mg/L MDMA and 0.0213 mg/L MDA). Pursuant to the forensic medical assessment, the described findings on her lips, and buccal mucosa were interpreted as an allergic and mechanical reaction (through continuous chewing and biting) to ecstasy.

Demographische und historische Analyse der Hamburger Hornhautbank uber 30 Jahre Purpose: To evaluate donor demographics, trends in donor tissue procurement and tissue storage over a long period. Methods: A retrospective, longitudinal, descriptive analysis was undertaken of data from the Hamburg Eye Bank Data Base (HEB-DB) that had been collected between 1981 and 2010. Data on 54 parameters of cornea donors [including clinical history, age, death cause, gender and death-to-explantation interval (DEI)]and of cultivated corneas (endothelial quality and development in culture, cultivation period, microbiological contamination) were retrieved. These data were analysed statistically, focusing on the historical development of the eye bank. Results: At the time of retrieval (June 2010), the HEB-DB contained data on 10 943 corneas (5503 donors). Most donors were men (65%) and had died from cardiopulmonary (n = 801) ⁄ cerebral (n = 261) failure or as the result of a polytraumatic accident ⁄ suicide (n = 602). Within these years, donor age,DEI and storage time increased. The percentage of stored corneas suitable forntransplantation displayed a variable but increasing trend; in 2007, almost 75% of the stored corneas were transplanted. Between 1995 and June 2010, the median microbiological contamination rate was 5.3%. A change in the procurement procedure from enucleation to corneoscleral explantation in 2008 led to a briefly increased contamination rate. Conclusion: Donor demographic data run parallel to the general demographic development. Our analysis indicates a dynamic development of the eye bank over the last 30 years and emphasizes the need for an active quality management in coping with the challenges of modern eye banking.

Die Leichenschau ist die letzte arztliche Tatigkeit am Patienten. Mit ihr erfolgt eine Einschatzung, ob die Umstande eines Todesfalles weiter untersucht werden sollten oder nicht. Primare Aufgabe des leichenschauenden Arztes ist die Feststellung des Todes. Dazu kommen Angaben zur Todeszeit, der Todesursache und der Todesart auf der Todesbescheinigung. Bei Anhaltspunkten fur einen nicht naturlichen oder ungeklarten Tod ist die Polizei zu rufen. Ein standardisiertes Vorgehen hilft bei der Leichenschau.

Die Todesfeststellung steht am Beginn jeder arztlichen Leichenschau. Unter Berucksichtigung sicherer Todeszeichen ist eine zweifelsfreie Einschatzung schnell und einfach moglich. Sind keine sicheren Todeszeichen vorhanden, ist zu reanimieren. Sichere Todeszeichen sind Totenflecke, Totenstarre, Faulnis sowie nicht mit dem Leben zu vereinbarende Verletzungen. Grundkenntnisse uber postmortale Veranderungen ermoglichen eine grobe Todeszeitbestimmung und konnen ggf. Hinweise auf die Todesursache geben.

Objective According to EU regulations (EU directive 2006/17/EC), blood specimens for virologic testing in the context of post-mortal tissue donation must be taken not later than 24 h post mortem.

Bei der auseren Leichenschau einer alten Frau fielen stichverdachtige Verletzungen unklarer Herkunft an den Beinen auf. Nachforschungen ergaben, dass diese Folge intraossarer (i.-o.-)Punktionsversuche unter Anwendung eines halbautomatischen Bohrersystems (EZ-IO®) im Rahmen der Notfallbehandlung waren. Fur den leichenschauenden Arzt ist die Kenntnis moglicher Verletzungen nach i.o.-Punktionen fur die Interpretation und Abgrenzung von Stich- sowie Misshandlungsverletzungen von Bedeutung.