Search

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

Die Untersuchung der Ossifikation des Schildknorpels ist nicht nur in Form von anatomischer und morphologischer Grundlagenforschung, sondern auch fur rechtsmedizinische Uberlegungen von Belang. Ziel war es, einen Geschlechts- und Alterspolymorphismus mittels Mikro-Computertomographie (µCT) nachzuweisen. An 53 autoptisch asservierten Kehlkopfpraparaten wurde eine mikrocomputertomographische Bildgebung durchgefuhrt. Die µCT eignet sich durch ihre hohe raumliche Auflosung und das nichtdestruktive Erschaffen dreidimensionaler Volumendatensatze zur quantitativen Analytik von Knochenstrukturparametern und zur Visualisierung von Unterschieden und Veranderungen der trabekularen Knochenstruktur. Dabei wurden u. a. Parameter bestimmt wie z. B. die Knochendichte, das Knochen- und Gesamtvolumen und ein eigens entwickelter Score fur die Art der Verknocherung. Sowohl ein Alters- als auch ein Geschlechtspolymorphismus konnten nachgewiesen werden. Die mannlichen und die alteren Schildknorpel sind deutlich starker trabekular und vollstandiger verknochert und weisen ein groseres Knochen- und Gesamtvolumen auf als die jungeren und die weiblichen Schildknorpel. Damit lasst sich ein Nutzen fur die Rechtsmedizin aufzeigen, mit dem Schildknorpel als Pradiktor fur das Geschlecht und das Alter eines Knochen- bzw. Leichenfundes.

Mittelbare Verletzungen der A. vertebralis sind beim Schutteltrauma des Sauglings und auch als Sturzfolgen forensisch gelaufig. Dagegen scheint die Frage einer Schadigung der A. vertebralis als Komplikation einer Therapie zunachst nicht naheliegend. Ausgehend von den Befunden zweier im Schrifttum mitgeteilter Todesfalle von Sauglingen nach durchgefuhrter Vojta-Physiotherapie mit schweren hypoxischen Schadigungen des Gehirns im vertebrobasilaren Stromgebiet werden auch manualmedizinische Techniken auf strukturelle Gefahrdungen der A. vertebralis hin untersucht. Die Vergleiche stutzen sich auf mitgeteilte anatomische, biomechanische und klinische Daten. Danach besteht bei durchaus gebrauchlichen manualmedizinischen Techniken ein hohes Verletzungsrisiko fur die A. vertebralis. Diese werden entsprechend als obsolet fur die Behandlung von Sauglingen, Kindern und Adulten angesehen. Dem stehen nichtrisikobehaftete Techniken gegenuber. Zur Uberwachung des Sauglings bei der manualmedizinischen Behandlung wird die Polygraphie fur erforderlich gehalten.

The concept of position-dependent cerebral hypoxaemia as a mechanical cause of sudden death in infants is based on the possibility of flow impairment in the large neck vessels (carotid and vertebral arteries) on marked rotation and (or) flexion of head and neck. To test this hypothesis systematic flow measurements were performed post-mortem with 21 different angles of head and neck in 16 infants who had died suddenly. The angles chosen were those taken especially during sleep with the infant in a prone position. The measurements demonstrated flow impairment, especially as a result of mechanical narrowing of both vertebral arteries. On the other hand, the range of variation in the internal carotid artery was marked and individual circumstances could not be estimated. There was no certain connection between flow impairment in the vertebral artery and possible increase in the carotid artery. The least dangerous extreme movement for an infant is dorsal flexion of the neck with reclining of the head, a favoured position of many infants. Particularly dangerous is flexion combined with rotation. Judged by the number of complete flow stoppages in the vertebral and carotid arteries, the danger is greatest with rotation in dorsal flexion. Since the dangers of supine position have been known for a long time, lateral position is urgently recommended as the sleeping position in infants.

This paper deals with 301 families who have been offered a consultation for managing bereavement following sudden infant death. Eighty-eight percent of the parents (269 families) accepted and 36 more families out with Lower Saxony wished to be cared for. Without a previous autopsy 1.172 contacts happened from 1989 to 2003 comprising primary crisis intervention and long-term care, the latter including saying farewell before and after autopsy. One main aim was a close linking with the international self-help organization of parents (GEPS). Single cases conferences were carried out for more than five years according to the Sheffield model. There is given the methodical basis and many details of the care project.

A total of 58 cases of fatal trauma (forensic autopsies) were investigated for lesions of the pelvic girdle, the pubic symphysis, and for injuries distant from the pelvis. Traumata of the pubic symphysis were present in 30% (n = 17) of the cases. The symphyses were examined by x-ray and macroscopically related to the main violence (Abbreviated Injury Scale [AIS]). A correlation between the latter and the severity of the resulting injuries could be deducted. Characteristic patterns of symphyseal injuries included small hemorrhages, partial and complete ruptures, and also ruptures of the ligamentary insertions, which have not yet been described. The kind and severity of these lesions related to the intensity/direction of the violence are demonstrated and discussed.

PURPOSE: To compare digital X-ray, CT, and MRI in the evaluation of ligamentous and osseous lesions in upper cervical spine specimens after artificial craniocervical injury with the findings of macroscopic preparation. MATERIALS AND METHODS: A rotation trauma of defined severity was applied to 19 human corpses. After dissection of the neck specimens, digital X-ray (DIMA Soft P41, Feinfocus), conventional and helical CT (CTi, High Speed, GE, collimation 1 mm; pitch 1.0), and MRI were performed from the skull base to C3. The findings were correlated with the macroscopic results of preparation. MR (Magnetom Vision, Siemens) imaging was obtained with a 1.5 T system using 2D- and 3D-sequences. RESULTS: Preparation revealed 6 fractures of the vertebral bodies, 5 fractures of the dens axis, 1 fracture of the arcus anterior of the atlas, 4 osseous flakes at the occipital condylus, and 6 lesions of the alar ligaments. Digital radiography showed all fractures and 4 osseous flakes at the occipital condylus. With conventional and helical CT, all fractures and all ruptured alar ligaments could be detected. 2D MRI depicted 9 of the fractures and 3D MRI showed fractures. With 2D MRI, 2 of the 4 osseous flakes at the condylus could be detected and with 3D MRI one occipital condylus fracture could be depicted. Ligamentous injuries were visualized by 2D MRI in 2 of 6 cases and by 3D MRI in one case. CONCLUSIONS: In post-mortem studies, CT was superior to MRI in the visualization of osseous and ligamentous injuries after trauma of the upper cervical spine. However, these results are not transferable to patients with rotation injury in general.

Trauer und depressive Syndrome gehoren zu den normalen Reaktionen von Eltern nach einem Plotzlichen Kindestod („sudden infant death”, SID). Wir berichten im folgenden aus psychiatrischer und rechtsmedizinischer Sicht uber 2 Falle, in denen die Mutter nach SID mit ausergewohnlich schweren Depressionen reagierten und sich selbst vorwarfen, sie hatten ihr Kind getotet. Abschliesend werden einige Empfehlungen fur die Betreuung betroffener Eltern mitgeteilt.

Nach der Todesurachenstatistik betrug die Inzidenz des plotzlichen Kindstodes von 1985 bis 1989 in der Bundesrepublik 1,55 Falle pro 1000 Lebendgeborene (1,51 bis 1,59). Es liegen jedoch bisher keine Angaben uber die Obduktionsfrequenz vor. Deshalb wurden rechtsmedizinische und pathologische Institute mit der Bitte angeschrieben, mitzuteilen, bei wie vielen Sauglingstodesfallen in der Zeit von 1985 bis 1989 nach der Obduktion die Diagnose eines plotzlichen Kindstodes gestellt wurde. Alle angeschriebenen 53 rechtsmedizinischen und 81,1% der 376 pathologischen Institute teilten uns die Obduktionszahlen mit, die mit den Angaben der Todesursachenstatistik verglichen wurden. Dabei ergab sich eine Obduktionsfrequenz von 55,2% mit nur geringen jahrlichen Schwankungen (51,1% bis 59,3%) und erheblichen Unterschieden zwischen den einzelnen Bundeslandern. Die hochsten Obduktionsfrequenzen wurden in den Stadstaaten Berlin (West) und Hamburg erreicht. Bei den Flachenstaaten wies Niedersachsen mit 77,8% die hochste Obduktionsfrequenz auf, wahrend in Rheinland-Pfalz von allen Bundeslandern die niedrigste Rate mit 20,1% zu verzeichnen war. Sowohl unter wissenschaftlichen, forensischen und arztlichen Aspekten sollte die Obduktionsfrequenz bei plotzlich verstorbenen Sauglingen in Deutschland erhoht werden.

The Condylus tertius is defined as a small bony hunch on the anterior surface of the clivus. Its presence means an enormous functional impairment of the upper head joint, looking at the 3-point-contact between the skull base and the upper cervical vertebrae. In 10 of the 2000 forensic examined bodies, analyses of neck vertebra + skull base revealed this feature. The origin of these findings is discussed, as stated in the literature of embryology, to be a suboccipital hypochordal plate. So in one of the cases the condylus was found at the hypochordal plate itself whereas the so-called socket was lying at the margin of the clivus. In three cases there was found a free body between the apex of the Dens and the Clivus forming a mobile Condylus tertius. In our opinion its position varies over the anterior arch of the atlas and the apex of the dens as a result of rotatory forces between the atlas and axis and physiological strain. Examples are given to elucidate this. There is a difference in the differentiation of the deposited material according to functional demand. A pressure bed (i.e. a Condylus tertius) is formed when a bony structure is deposited on the clivus. This functional prospect relativises the hypothesis of a purely constitutional genesis of the Condylus tertius. A fracture of the hypochordal clasp being joined with a bony connection to the anterior atlantic arch is described for the first time.

Alterations in the heart rate were monitored before, during and after the application of a unilateral mechanical impulse to the high cervical spinal cord region which was administered strictly in connection with the so called manual therapy (diagnosis= KISS). The investigation is based on a survey of 695 infants between the ages of 1 and 12 months. A notable change in the heart rate was evident in 47.2% of all examined infants (n= 695). In 40.1% of these infants, the change in heart rate was characterized by heart rate decrease of 15-83% compared to control conditions. Infants in their first 3 months of life responded more often with a severe bradycardia (50-83% decrease), older infants (7-12 months) more often with a mild bradycardia (15-49.9% decrease). This comparison revealed a significantly increased occurrence of severe bradycardia in the younger age group compared to the group of children >3 months (significance 0.0017). In 12.1% (n= 84) of the infants, the bradycardia was accompanied by an apnea. We discuss the hypothesis that mechanical irritation of the high-cervical region serves as a trigger that may be involved in sudden infant death (SID).

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

To compare digital X-ray, CT, and MRI in the evaluation of ligamentous and osseous lesions in upper cervical spine specimens after artificial craniocervical injury with the findings of macroscopic preparation.A rotation trauma of defined severity was applied to 19 human corpses. After dissection of the neck specimens, digital X-ray (DIMA Soft P41, Feinfocus), conventional and helical CT (CTi, High Speed, GE, collimation 1 mm; pitch 1.0), and MRI were performed from the skull base to C3. The findings were correlated with the macroscopic results of preparation. MR (Magnetom Vision, Siemens) imaging was obtained with a 1.5 T system using 2D- and 3D-sequences.Preparation revealed 6 fractures of the vertebral bodies, 5 fractures of the dens axis, 1 fracture of the arcus anterior of the atlas, 4 osseous flakes at the occipital condylus, and 6 lesions of the alar ligaments. Digital radiography showed all fractures and 4 osseous flakes at the occipital condylus. With conventional and helical CT, all fractures and all ruptured alar ligaments could be detected. 2D MRI depicted 9 of the fractures and 3D MRI showed fractures. With 2D MRI, 2 of the 4 osseous flakes at the condylus could be detected and with 3D MRI one occipital condylus fracture could be depicted. Ligamentous injuries were visualized by 2D MRI in 2 of 6 cases and by 3D MRI in one case.In post-mortem studies, CT was superior to MRI in the visualization of osseous and ligamentous injuries after trauma of the upper cervical spine. However, these results are not transferable to patients with rotation injury in general.

The aim was to evaluate contamination by bone-dust and formaldehyde when using a band-saw for preparations of the base of the skull and the cervical vertebral spine (stationary band-saw, 1400 upm, saw blade with 160 saw teeth/m; distances 19–26 cm, time intervals 55–90 s). The asservation of bone particles was done with adhesive microscopic slides and calcium-specific staining by alizarin-red. The quantification of air contamination was carried out with micrometry and a particle-counter. Drager-tubes R 0.2/9 were utilized for estimation of formaldehyde. The band-saw did not produce high amounts of bone-dust with suspension power. Nevertheless, 75% of the particles ranged below 5 μm in size and were respirable. Contamination decreased with an increasing height above the floor. A massive flow of particles was observed during the first minutes of sawing. The bone-dust spread some metres away. The formaldehyde levels ranged throughout between 0.5 and also over 5 ppm (MAK=0.5 ppm). This fact makes clear an intensive contamination of the air. Therefore, a ventilation directed to the floor is necessary when a band-saw is used, as well as breathing masks and safety-goggles.

The aim of this study was to investigate vegetative reactions in infants after mechanical irritation of the suboccipital region. The investigation is based on 199 infants who were observed while being treated with a suboccipital impulse (manual therapy). The results revealed vegetative reactions in more than half of all cases (52.8%, n = 105). The frequency of such vegetative reactions observed was at follows: flush 48.7% (n = 97), apnoea 22.1% (n = 44), hyperextension 13% (n = 26), and sweating 7.5% (n = 15). It is pointed out that approximately 25% of all the infants examined reacted by apnoea due to a mechanical irritation of the suboccipital region. This symptom was part of an extensive vegetative reaction. This method of inducing an apnoea has not yet been described; from this it follows that there are close relations to sudden infant death.

Airborne infections are well known in clinical medicine (transport of bacteria by aerosols). During autopsies floating, respirable kinds of bone dust are produced, depending on the type of saw. Experiments were carried out with oscillating saws (without/with exhauster) and manual saws (autopsy of cranial cavity). The intention was to characterize and quantify the sawdust produced by the different saws. Furthermore, we wanted to find out whether bacteria are transported by these aerosols. Bone dust was collected with adhesive microscopic slides. Alizarin red was used for solid histochemistry of bone particles. Quantification was carried out by an eyepiece micrometer. Airborne particles and bacteria were identified macroscopically per unit of time. The oscillating saw without exhauster produced sawdust in large quantities. This dust was respirable and had suspension power for hours. There was a remarkable reduction of sawdust by an integrated exhauster. Spreading of particles carrying bacteria/saccharomycetes was seen over 6-8 m. There is a very low risk of an airborne infection when utilizing a manual saw (production of particles similar to chippings, absence of suspended sawdust). It is necessary to take every precaution against airborne infections by wearing breathing masks and safety goggles when using an oscillating saw.

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

A 19-year-old man was admitted to hospital because of uncharacteristic neurologic symptoms. During the first examination morphologic alterations due to an injection of mercury into the left arm and the left side of the trunk were found. The dose and the manner of application were doubtful and suspected to be a case of self-infliction. The man informed the police only 7 months later because his relatives had finally persuaded him to do so. The description of the infliction by unknown perpetrators was full of contradictions. Initially the patient gave only an indistinct description. But later on, the number of details increased. At the same time there was a change in the characteristics of the perpetrator(s). Other differences existed concerning a loss of consciousness which should have been caused by a single stroke on an arm. Furthermore, the patient told about a swelling as big as an egg, provoked by an injection of liquid mercury. It could be shown by experiments that mercury can be injected into soft-tissue very simply and that it spreaded widely. Arguments for a self-injection were e.g. the technical possibility, the topography of the injection marks, and an easy handling of the syringe. A psychiatric examination furthermore revealed, that the patient had had periods of restriction of thinking, sometimes combined with a lack of appreciation.

Injuries following autoaggressive behaviour are found in patients examined in forensic medicine as well as in psychiatric clinics. Self-mutilation often is combined with a borderline personality disorder in psychiatric patients. Our investigation compares injuries and wounds in psychiatric patients and those in persons examined in the Institute for Forensic Medicine after referral by the police. Our intention was to show evident differences and/or conformities in both of these groups. Additionally we describe a 'third group' of patients which has not yet been mentioned. These women showed, at the same time, characteristics of patients with overt self-injuries and of those with non-overt self-injuries. In this 'third group' we can often find a mixture of reality and fantasy/imagination.

Weichteilverletzungen uberwiegen am okzipitozervikalen Ubergang (C0/2) selbst bei todlichen Traumata weit gegenuber knochernen. Auch bei der Non-contact-Verletzung sind sie bestimmend, wenngleich Unterharnscheidt (1986,1992,1993) zeigen konnte, das subtotale Schadelabrisse als Folge der Traktion durch Massenkrafte moglich sind.

Bei der Mehrzahl sterbender Menschen ist der Todeszeitpunkt prognostizierbar. Spatestens in der Finalphase werden sie in ein Krankenhaus eingeliefert und sterben dort.

The two-allelic polymorphism of the haptoglobin system has been used in cases of disputed paternity for more than thirty years. A lack of methods suitable for routine subtyping of the Hp α-chains hindered it from being commonly used in paternity testing. Today various methods, based on somewhat different principles, have been established. Patzelt and Schroder (1985), inspired by the work of Shibata (1982), developed a time-saving procedure of Hp subtyping by isoelectric focussing of haptoglobin cleavage products. We are performing this technique with slight modifications in routine paternity testing. The aim of this study is to present the distribution of the Hp polymorphism in 431 unrelated adults from Lower Saxony.

Puncture of a major cervical veins for insertion of a central venous catheter is a standard-method in resuscitation performed in emergency conditions. Even extensive lesion-marks due to punction are customarily seen by medico-legal practitioners, but in detail they may cause difficulties in differential diagnosis, when lesion marks caused by acts of violence directed straight against the neck are to be differentiated. Especially in the primary phase of inquiry about crimes of homicide these injuries due to punction are forensically important. Therefore frequency and methods of resuscitation efforts were evaluated in 453 crimes of homicide, committed in Göttingen and Berlin (subjects given by the Free University). Findings of the present study were that resuscitation measures were taken merely to a rate of 25%, and in proceeding a central venous catheter was not obligatorily inserted, moreover proceeding being regionally different. In Berlin a central venous catheter was inserted in 17 cases out of 77 resuscitated homicidal injuries, the rate being 24 cases out of 36 cases in Göttingen. In altogether 8 crimes of homicide committed by immediate attacks against the neck, a cervical vena was punctured, findings later being extensive effusions of blood marked around the tapped spot. The different ways to perform resuscitation may justify to point also at the forensic interest to discover the facts together with complete diagnosis in cases of crimes of homicide. That is why it may be vindicated to try to find out a proceeding, which does not lessen the effectiveness of resuscitative manoeuvres, yet by means of which forensical concerns are taken into consideration, too.(ABSTRACT TRUNCATED AT 250 WORDS)

Most cases of disputed paternity can be adequately resolved by testing the conventional blood group, serum and enzyme systems, perhaps completed by testing the HLA system. The analysis of DNA polymorphisms is a very useful additional system for distinguishing falsly accused non-fathers from “true” fathers and for providing convincing evidence in favour of paternity in cases of non-exclusions. The purpose of this presentation is to report the results from some extraordinary paternity cases in which the analysis of DNA polymorphisms greatly helped clear up the paternity.

In 30 households with SIDS the drinking-water was studied microbiologically and chemically regarding its bacteriological contents, also it was checked for Pb and Cu. Three test solutions of 45 bacteriologically researched samples revealed significant data. One sample showed 2400 cfu "colony forming unit" which is more than double the number of germs permissable in an drinking-water container according to the standards of drinking-water (TrinkwV) 1(3). Also Ps. aeruginosa were found. A further sample contained 3300 cfu Coliforme (E. cloace in 100 ml). The lower quality of a further samples with 2.6 x 10(6) cfu could be retrospectively explained by works done by the Berlin City Works (Berliner Wasserwerke). Enteric bacteria could not be revealed. The remaining 42 samples were within the criteria Section 1 [(1), (2), (3)] of the drinking-water standard. Samples which fulfilled the norms of Section 1 (3) TrinkwV for reserve containers with up to 1000 cfu can be explained by the known fact that water in pipes (containers) can easily be contaminated from outside, for instance through germs like Pseudomonades. In none of the samples a connection between water quality and bacteriological post-mortem findings could be found. In two groups concerning the research for heavy metal the amount of Pb did not surpass the limit of drinking-water standards. In several cases the amount of Cu surpassed that of Pb. Bacteriological-chemical water research in households with suspicion of SIDS are only useful if anamnestical, clinical and autoptic data can be brought into a close temporary and spatial order and if the findings can be controlled through repeated research.(ABSTRACT TRUNCATED AT 250 WORDS)

In einer Ubersicht werden Ausmas und Form der HWS-Verletzung beim suizidalen Erhangen dargestellt. Dabei handelt es sich um eine Weichteilverletzung der Halswirbelsaule ohne Ruckenmarkbeteiligung.

Originating from a 1995 congress of forensic pathologists in Liabeck (Germany), the articles in this volume present a variegated analysis of the medical and legal, philosophical, and theological aspects of the euthanasia debate in Germany, supplemented by the experience and opinions of authors from neighboring European countries like Holland (Visser), Norway (Rognum), and Switzerland (Bar). The book contains almost 20 articles; although the texts are written in German, each article begins with a summary in English.

Ein Vergleich der Phospholipidkonzentration im Serum von Herz- und Sinusblut mit dem Hamolysegrad dieser Blutproben, dem Lebensalter, Geschlecht, Arteriosklerosegrad und der Todesursache bei 145 unselektierten Leichen, die nicht faulnisverandert waren, ergab trotz breiter Streuung der Einzelwerte eine Abhangigkeit von der Todesursache, nicht jedoch von Alter, Geschlecht und dem Arteriosklerosegrad. Wahrend mit geringeren Stufen der Hamolyse eine Abnahme der Phospholipidkonzentration einherging, deutete sich bei ausgepragter Ha molyse eine Zunahme an. Die Analyse der Ergebnisse von 46 Todesfallen durch Erhangen erbrachte eine Bestatigung der grundlegenden Untersuchungen von Berg, wonach vermehrt Phospholipide in Sinne einer vitalen Reaktion wahrend des Strangulationsvorganges ausgeschuttet werden. Als Folge der Halsgefaskompresion ergaben sich dabei statistisch gesicherte Unterschiede in der Phospholipidkonzentration im Serum von Herz- und Sinusblut.

In the archives of the accident hospitals available, the data of patients who had been hospitalized because of a penetrating or blunt abdominal trauma in the last two years before the surveys were evaluated. Besides the abdominal trauma, at most trivial injuries of other regions were permitted. The data which might give information on how massive the intraabdominal injury was and/or the severity of shock symptoms were taken from the patient record sheets. Afterwards, it was attempted to obtain in an interview details on the external circumstances, the course of the accident event itself and the nature of the reaction to the trauma. Finally, 32 casualties (14 with penetrating and 18 with blunt abdominal injury) were surveyed. Fundamental differences in the behavior of these two subgroups were detected and verified with statistical test techniques. Circumspect behavior after penetrating abdominal trauma was characteristic. Nevertheless, in a few cases there was loss of the ability to act even in limited penetrating injury of the abdominal wall. However, the casualties themselves had the impression of a severe stab injury and this determined the primary reaction to the trauma. A fundamentally different behavior pattern was shown by those who had suffered a blunt abdominal injury. For them, it was typical that they became unable to act immediately or within a few seconds. With regard to the significance of pain, the restriction of motor movements as well as the relation of assumed and clinically verified injury severity is dealt with in respect of the capacity to act in a comparison of the two subgroups.

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

In order to prove the diagnostic value of cervical discography, a postmortem investigation was carried out on 70 trauma fatalities and 30 atraumatic fatalities of comparable age distribution. It was shown that, depending on the functional state of the intervertebral disk, the contrast medium flowed from the central depot into the "degenerative" cleft systems, from there frequently in front of the posterior longitudinal ligament into the uncovertebral joints and from there into the epidural space even in injured movement segments. On the other hand, despite the large number of false positive results only a relatively small percentage of the injuries was investigated. Discography would be a specific diagnostic method merely for central intervertebral disk disruption. However, this injury type is a rare special form.

The intradural sagittal diameter at the second cervical vertebra (SD/C2) of 62 SIDS cases was measured myelographically. This SD/C2 proved to be dependent on body size, body weight, and age. A clear, age-dependent difference is to be found in the primarily narrow spinal canal. This parameter (SD/C2), which is more precisely defined in adults on the basis of clinical, radiological, and autopsical findings is assumed to have the value of 0.5 cm in the first 2 months, 0.6 cm in the third month, and 0.65 cm in the fourth month. The resulting potential danger to infants is dependent upon their position. The SD/C2, was significantly decreased in extension as compared to a neutral posture. With consideration of the primarily narrow spinal canal in the infant, there is, according to our measurements, a potential hazard for the infant in any further, significant shortening of the SD/C2. This is independent of the width of the spinal canal under maximal extension. We found individual cases in which the SD/C2 was decreased by almost 50% from the normal value in neutral position. No correlation was found between the primary width of the spinal canal and the degree of luminal reduction upon extension.

Radiological and patho-anatomical investigations of the spines of 32 corpses of persons who had committed suicide by hanging revealed spine damage in 81% of the cases. The cervical spine was damaged in 69%, the lumbar spine in 56% of the cases. The typical damage of the cervical spine is a loosening of the discs at the dorsal side, usually at the level of C 4/5 to C 6/7. In the region of the lumbar spine, bleeding between the (anterior) ventral ligament and the discs is the most frequently observed damage (Simon's sy;mtpom). Simon bleeding is brought about by traction force and is not dependent on the age at death or on any existing degenerative changes of the spine.

Nach einer Definition des Begriffs Schleudertrauma wird der Anteil derartiger Verletzungen anhand 334 unausgewahlter todlich Traumatisierter in einem gerichtsmedizinischen Obduktionsgut mit 12% angegeben. Verletzungen des Halses fanden sich in diesem Kollektiv in 76%, nur die Halswirbelsaule betreffende in 68%. Allein in 20% waren diese indirekten Verletzungen der HWS als Todesursache anzusehen.