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Abstract: The morphology of bloodstain distribution patterns at the crime scene carries vital information for a reconstruction of the events. Contrary to experimental work, case reports where the reconstruction has been verified have rarely been published. This is the reason why a series of four illustrative cases is presented where bloodstain pattern analysis at the crime scene made a reconstruction of the events possible and where this reconstruction was later verified by a confession of the offender. The cases include various types of bloodstains such as contact and smear stains, drop stains, arterial blood spatter and splash stains from both impact and cast-off pattern. Problems frequently encountered in practical casework are addressed, such as unfavourable environmental conditions or combinations of different bloodstain patterns. It is also demonstrated that the analysis of bloodstain morphology can support individualisation of stains by directing the selection of a limited number of stains from a complex pattern for DNA analysis. The complexity of real situations suggests a step-by-step approach starting with a comprehensive view of the overall picture. This is followed by a differentiation and analysis of single bloodstain patterns and a search for informative details. It is ideal when the expert inspecting the crime scene has also performed the autopsy, but he definitely must have detailed knowledge of the injuries of the deceased/injured and of the possible mechanisms of production. [Copyright &y& Elsevier]

Abstract: A total of seven detailed death investigations is reported where death occurred while being restrained by a belt or a protective cover. The casualties were elderly persons who mostly showed considerable pre-existing diseases, especially dementia and coronary atherosclerosis. Concerning the cause of death, three groups were differentiated: (I) mechanical asphyxia from strangulation. (II) Mechanical asphyxia from thoracic/abdominal compression. (III) Compression of thorax/abdomen without clear signs of asphyxia. Subgroups II and III each involved one case of rib fractures without preceding resuscitation. In subgroup III, the presence of considerable compression of the trunk and the absence of a natural cause of death strongly indicate a causal connection between compression and death, e.g. from a shortened course of fatal asphyxia, endocrine stress reactions or a head-down-position: cardiac arrest in a helpless situation. The method of restraint was inadequate in most cases in that only one device was used which did not restrict the capability to move sufficiently. A good clinical documentation including medical indication, duration and method of restraint and a description/photograph of the original on-site appearance is essential but was not present in most cases. Therefore, prophylaxis is based on a clear medical indication, the proper use of restraint devices, detailed instructions of the nursing personnel and close monitoring. The forensic investigation should aim at a complete reconstruction based on autopsy, histology, toxicology and inspection of the scene and the medical records. [Copyright &y& Elsevier]

A case of malignant hyperthermia (mh) in a 27-year-old man is described. In a first anaesthesia using isoflurane and succinylcholine, the end-tidal CO2 rose from 39 to 49 mmHg 2.75 h post-intubation and the body temperature rose to 39.8 °C 14 h post-intubation but was normal again the next day. In a second anaesthesia using the same medication, the maximal end-tidal CO2 was 44 mmHg and the body temperature rose to 39 °C after 9 h. After 4 days, the fever rose to 40 °C, and to 42 °C when death occurred 10 days after the second anaesthesia. Masseter spasms or muscle rigidity were never present. According to the death certificate, death was due to multi-organ failure from sepsis. At autopsy, the skeletal muscles were pale and oedematous. Histology demonstrated focal necroses in the skeletal muscles, shock kidneys with myoglobin excretion and myoglobin clots in small blood vessels of the lungs. Hence, the postmortem diagnosis “malignant hyperthermia” was established but accusations of medical maltreatment were rejected because of the atypical and protracted clinical course and because uncharacteristic signs of malignant hyperthermia were attributable to the clinically suspected sepsis. [Copyright &y& Elsevier]

Fatalities caused by electrocution (n=37) were re-examined on the basis of the autopsy records, the police reports and the technical expertise. Accidents including two lightning deaths caused 2/3rd and suicides 1/4th of the fatalities and there were two homicides. Carelessness or ignorance were a major reason for accidental deaths while technical defects could be verified in five cases only. Low-voltage ac and male victims predominated. Electrical burns or current marks were detected in 81% including all high voltage electrocutions. The seven victims lacking burns were electrocuted in a wet environment including six cases of suicide in the bathtub with a hair drier. Petechial haemorrhages were present in 74% of the cases and the favourite sites were the skin of the eyelids, conjunctivae, visceral pleura, and the epicard. The presence of petechiae did not depend on the voltage or the current pathway relative to the heart. It is, therefore, suggested that the petechiae are not caused by asphyxia but by a combination of venous congestion due to cardiac arrest and a sudden rise in blood pressure induced by muscle contractions. Consequently, “electrical petechiae” represent a non-specific but typical finding in electrocution irrespective of the mechanism leading to death. Unlike electrical burns, petechiae also indicate the vital origin of the events. The relevance of this typical morphological sign in the examination of possible electrocution fatalities is therefore emphasised. [Copyright &y& Elsevier]

Abstract: A case of homicide is reported where a woman was killed by her boyfriend. He used a dagger-like fragment of a broken window glass to cause 10 atypical stab wounds to the neck and face and several incised wounds in other body regions. The cause of death was exsanguination, mainly from a severed internal jugular vein. The morphology of glass fragment injuries, both in the victim and perpetrator, is discussed and the possibility of homicide in such cases, which commonly represent accidents, is stressed. The use of an unsuited sharp force weapon carrying a high potential for self-injury can be explained by an excited state of mind. [Copyright &y& Elsevier]

Background: In Germany it is required by law that basically every type of physician needs to be capable of executing a correct external post-mortem examination of a corpse. In recent years, numerous investigations on external post-mortem examinations repeatedly reported systematic mistakes and erroneous procedures in various clinical and medicolegal case groups. Accordingly, the completion of death certificates is frequently performed incorrectly. As one of the typical unnatural death cases, decedents dying from fatal head trauma (FHT) represent a special autopsy case group, which is expected to be correctly recognized during the primary external post-mortem examination because the external injuries are mostly obvious.Objective: The present study aimed at investigating the quality of the external post-mortem examination in medicolegal FHT cases by means of comparison of death certificates and autopsy reports from a 10-year period.Material and Methods: In a retrospective study design all autopsy cases from the Institute of Legal Medicine of the University Hospital Münster in the years 2006-2015 (n = 3611) were analyzed as to the presence of FHT. A total of 328 cases with FHT and the concomitant presence of a death certificate filled out before the autopsy were identified. Subsequently, the cause of death according to the death certificate was compared with the cause of death according to the autopsy. The degree of agreement was classified into six different categories from I to VI. While category I represented a complete lack of agreement, category VI was assigned to cases with full agreement.Results: In 58.5% of the cases (category VI) FHT was identified correctly during the external post-mortem examination. In 1.5% of the cases, a completely different cause of death was determined during the external post-mortem examination (category I). In 19.2% of the cases, no cause of death or the statement "unclear" was given as the cause of death in the death certificate (categories II and III). Cross-analyses and intuitive heatmap visualization were generated to identify case constellations with an increased risk for discrepancies. These analyses revealed that among all discrepant cases (categories I-V), falls were found significantly more often than in the nondiscrepant cases (p < 0.01), especially falls of women older than 57 years (median age of women) or falls considered as accidents by the examiner. In addition, traffic-associated FHT of men older than 44.5 years (median age of men) was identified more frequently in the external post-mortem examination.Conclusion: Despite the fact that FHT should be a cause of death that is comparably easy to identify during external post-mortem examination, more than one third of the cases were not sufficiently recognized. Therefore, special attention must still be paid to certain case constellations during the external post-mortem examination. Typical examples of such cases are burned bodies, cases of advanced putrefaction and falls. [ABSTRACT FROM AUTHOR]

Abstract: The morphology of burn injuries in 120 consecutive patients from the Department of Plastic and Reconstructive Surgery, CHR, Hospital B in Lille was correlated to the etiology and type of heat. Analysis identified five typical patterns of cutaneous burn injuries. Jet of flame-pattern from methylated spirits and gasoline detonations: superficial burn injuries; sparing of skin wrinkles and the submental region; absence or small amounts of soot; preference of exposed body regions, esp. the face and hands. Explosion-pattern from explosions and electrothermal injuries: superficial burn injuries; sparing of skin wrinkles but not of the submental region; soot; preference of exposed body regions. Alveolar soot arrangement and metallisation in electrothermal injuries. Considerable third-degree burns in dust explosions. Flame-pattern from direct flame effects due to burning gasoline or oil, open fires or ignited clothing: nonuniform depth including large third-degree burns; no sparing of the submental region; soot; preference of body regions covered by clothing. Immersion-pattern: superficial (bullous) injuries; blurred junction between scalded and unscalded areas; extremities, buttocks, and back are favourite sites; cave child abuse: waterlines and zebra-burns. Spilling-pattern: superficial injuries; sharp junction between scalded and unscalded areas; head, anterior trunk, and upper extremities are favourite sites; running off and splashing stains. Consideration of these patterns can assist the reconstruction in fire investigations or unclear scaldings. In cases of suspected arson, a typical burn injury pattern or a single finding not compatible with the rest of the pattern can disprove a suspect or raise the level of suspicion. [Copyright &y& Elsevier]

A high-throughput axial MALDI-TOF mass spectrometer utilizing a laser with a 2-kHz pulse repetition-rate was constructed and tested. This fast mass spectrometer provided a data acquisition rate 10 times faster than a conunercially available (200 Hz) axial mass spectrometer, while maintaining comparable limits of detection (200 amol of Glu fib peptide). Mass resolution, only slightly less than the commercial instrument (10 000 vs 14000), was sufficient for baseline resolution of isotopic clusters of peptides with m/z <2700. A new method of mass calibration, which combined a limited number of internal and external standards, provided the same 15 ppm mass accuracy over the entire sample plate on either instrument. Implementing the 2-kHz laser required a faster data acquisition system and high-voltage pulse electronics, together with a novel strategy for rapid sample plate movements during acquisition, to achieve a sample analysis rate of up to 2 spots/s (with 800 shots/spot). The overall performance of the fast MALDI-TOF MS instrument was demonstrated by the acquisition, in 12 min, of an LC-MS data set from a plate of 625 fractions collected during LC separation of an 16O/18O differentially labeled proteomic sample of a tryptic digest of an E. coli lysate. [ABSTRACT FROM AUTHOR]

Abstract: An extraordinary case of a young woman with a gunshot wound to her left hand is presented. A typical near-contact entrance wound at the palm of the hand, extensive soft tissue destruction including nerve and vessel injury and a large stellate exit wound at the back of the hand were diagnosed and surgically treated. The woman initially stated that she had tried to repulse the pistol when a man shot her from close-range, which is consistent with the injury findings. After questioned thoroughly, however, she confessed self-infliction using a 8mm blank pistol. This case demonstrates that a self-inflicted injury simulating a criminal offence can be present even if very atypical features such as the use of a firearm and mutilating or defence-like injuries clearly speak against it. [Copyright &y& Elsevier]