Search

The prevalence of cardiac implantable electronic devices (CIEDs), pacemakers and implantable cardioverter defibrillators (ICDs) is increasing. However, postmortem analysis of CIEDs is not performed routinely. Fourteen consecutive CIEDs were analyzed. The indication for and date of implantation, technical data, CIED reprogramming, heart rhythm disturbances, patient demographics and medical consultations were investigated. Death during the first year after implantation was seen in 54%, whereof 71% consulted a physician within 10 days before death. The time of death was attributed to a particular day in 29%. There was a relationship between CIEDs and cause/manner of death in 50%. Although limited by a small sample size, this study advocates the routine postmortem CIED analysis for forensic and clinical purposes in selected cases. Patients with CIEDs seem to show an increased risk of death during the first year after implantation. The analysis of CIEDs can be helpful in evaluating the time/cause/manner of death.

BACKGROUND Rib fractures are common and potentially life-threatening. Fast and correct detection as well as comprehensive visual overview of rib fractures are of clinical and forensic importance. This study compared two computed tomography (CT) reformation methods, curved planar reformation (CPR) with conventional multiplanar reformation (MPR), regarding detection of rib fractures in different readers. METHODS Twelve postmortem CT datasets were retrospectively assessed for rib fractures using CPR and MPR. After defining the gold-standard regarding side, level, localization, and quantity of fractures, four reader groups per two readers consisting of radiologists, trauma surgeons, forensic pathologists, and laypersons, were evaluated for sensitivity, proportion of false positives, time to fracture detection, and subjective preference. RESULTS Overall sensitivity for fracture detection did not vary significantly between both methods. However, it was significantly higher in trauma surgeons and laypersons when reading CPR compared to MPR (70.7% vs. 62.0%, p=0.038 and 33.7% vs. 22.1%, p=0.003 respectively). It was significantly lower in radiologists (63.8% vs. 76.8%, p=0.001). Forensic pathologists performed similarly with both methods (53.6% vs. 56.5%, p=0.549). All non-radiologists preferred the use of CPR (75%). All readers found CPR to provide better visual overview (100%). CONCLUSION CPR may increase rib fracture detection rates of non-radiologists (i.e. trauma surgeons and laypersons) and provides a better visual overview. However, radiologists achieve higher fracture detection rates when allowed to work with the software tools they are more experienced with. The overall sensitivity was improvable and better visualization methods are warranted in order to avoid misdiagnosis and medicolegal errors regarding rib fracture detection.

Background Preventive measures and a causal therapy for type 1 diabetes (T1D) remain elusive. An imbalance between different dendritic cells (DC) with increased immunogenic DC and decreased tolerogenic DC (tDC) may lead to T1D. Furthermore, 25(OH)D 3 is associated with less adverse effects than 1,25(OH) 2 D 3 . Purpose The present study was performed to clarify the remaining issues about the cellular effects of 25(OH)D 3 in patients with T1D and the role of genetic polymorphisms of the vitamin D 3 (VD 3 ) metabolism on a functional cellular level. Materials and methods Twelve patients with T1D were case-matched to twelve healthy controls (HC). Monocytes (MC) were either not supplemented or supplemented with 25(OH)D 3 in vitro and phenotyped with fluorescence-activated cell sorting. In vitro synthesis and plasma levels of 25(OH)D 3 and 1,25(OH) 2 D 3 were analyzed as well as twelve gene polymorphisms of the VD 3 metabolism. Results 25(OH)D 3 significantly inhibited differentiation of MC into DC and led to an increase of intermediate cells (IC), which show a similar phenotype as tDC. The patient with a recent onset of T1D showed a higher increase in MC and IC compared to patients with long-standing T1D. There were significant differences for the increase of IC with supplementation of 25(OH)D 3 between different genotypes within the polymorphisms of VDR-BsmI-rs1544410, VDR-TaqI-rs731236 and CYP24A1-rs927650. Conclusion This study suggests that 25(OH)D 3 shows immunomodulatory effects on a cellular level in patients with T1D and HC by inhibiting the differentiation of MC into DC and promoting the formation of IC, which are similar to tDC, thereby shifting immunity to self-tolerance. The potency of 25(OH)D 3 did not differ between patients with T1D and HC. Increased plasma levels of 25(OH)D 3 may inhibit a proinflammatory cell milieu. Despite of the limited patient number, this study generates the hypothesis that the immunmodulatory effects may be influenced by genotypes of the VDR and CYP24A1 illustrating their functional role in T1D susceptibility, which is worth further investigation.

The objective of this case report was to highlight the benefit of postmortem imaging in the detection of focus of infection and inflammation in minor accessible neck regions. However the cooperation of postmortem imaging, external inspection and autopsy was constructive. Forensic imaging included a routine whole-body postmortem computed tomography (PMCT) using a dual-source CT scanner (Flash Definition, Siemens, Forchheim, Germany). Initial external inspection and subsequent autopsy were performed. The imaging results revealed focused emphysema of the neck descending to the mediastinum. External inspection showed unusual, cervical greenish discoloration; the autopsy exposed swollen palatine tonsils; and acute, purulent tonsillitis was the focus of infection. Ultimately an acute heart failure due to a septic shock resulted. Postmortem imaging supports medico-legal investigation with external inspection and autopsy in detecting the focus of infection in the palatine tonsils and in challengingly reachable anatomic areas such as neck regions. Literature recommends computed tomography with contrast media and magnetic resonance imaging for the detailed visualization of this body region for the living. According to our experience, we support this recommendation also for the deceased.

Background Self-inflicted injuries are a known, but challenging topic in the healthcare sector and the judicial system. Therefore, differentiation of these injuries from a third-party-interference is crucial in the field of forensic medicine. However, self-painted injuries with makeup, which entail misleading of medical staff and the administration of justice, have apparently not been described in the literature so far. Case A case of a rare kind of victim role staging in a 26-year-old Caucasian woman in the field of forensic medicine is presented. She supposedly had been robbed and harmed by two unknown men. The forensic examination revealed subjective symptoms and objective findings, such as skin discolorations appearing as fresh bruises. However, a closer look revealed makeup. After removal, no injuries were seen. Conclusions Awareness of the existence of exceptional cases of victim role staging is essential in the daily routine of healthcare, judicial and forensic professionals. Therefore, a questioning attitude within the physical examination as well as proper assessment of objective findings is crucial. Furthermore, the importance of an interdisciplinary approach of possible factitious disorders is demonstrated. The sensitization may exclude a third-party-interference, prevent damages to the health care system, avoid misleading of the administration of justice, and, therefore, reduce socioeconomic costs. Moreover, the recognition may enable adequate interventions and provide patients with professional help.

Purpose: Documentation of forensic radiological observations in postmortem imaging of electrical injuries is not common yet and is less prevalent compared to other forms of burn injuries. However, electrical injuries have high morbidity and mortality. The objective of this case report was the visualization and evaluation of unique electrocution-related injuries by postmortem contrast and non-contrast enhanced imaging compared to a forensic autopsy. Methods: Forensic imaging included whole-body postmortem computed tomography (PMCT), PMCT-angiography (PMCTA), postmortem magnetic resonance tomography (PMMR), and PMMR-angiography (PMMRA). Initial external inspection and subsequent autopsy were performed. Results: Imaging results revealed intestinal mucosal pathologies, particularly of the gastric vascular integrity and remarkable rhabdomyolysis of the striated muscles of the extremities. Furthermore, PMCT and PMCTA revealed a hepatic lesion with perihepatic free fluid. The results from external inspection and autopsy correlated to the well-known pathologies of electrocution in the course of a high-voltage incident. Conclusion: Postmortem imaging visualized electrocution-related injuries and aided substantially in the medico-legal investigation. These findings, particularly of the rhabdomyolysis in magnetic resonance tomography, may support the future image interpretation of cases with electrical injuries—in the living and the deceased.

Interpersonal violence represents a widespread phenomenon with a high prevalence. Consequences of these acts of violence are serious and extensive to the victims and from a socio-economic point of view. Physical examination of the victims is a key aspect in the medic-legal expertise. This article describes the basic principles and the standard procedures in conjunction with the examination of violent crime victims.Interpersonelle Gewalt stellt ein weit verbreitetes Phänomen mit hoher Prävalenz dar. Die Folgen von Gewalttaten sind für die Betroffenen und aus sozioökonomischer Sicht oft schwerwiegend und weitreichend. Die Untersuchung von Opfern häuslicher und sexueller Gewalt ist ein Schwerpunkt der rechtsmedizinischen Begutachtungstätigkeit. Der folgende Artikel beschreibt die Grundlagen und das Vorgehen bei der rechtsmedizinischen Untersuchung von Gewaltopfern.La violence interpersonelle représente un phénomène répandu et fréquent. Les conséquences d'actes de violence sont souvent graves et de longue portée pour les parties prenantes ainsi que dans une perspective socioéconomique. L'examen de victimes de violence sexuelle et domestique est un thème central de l'expertise judiciaire. L'article suivant décrit le fondement et les procédés d'examen.

Interpersonelle Gewalt stellt ein weit verbreitetes Phänomen mit hoher Prävalenz dar. Die Folgen von Gewalttaten sind für die Betroffenen und aus sozioökonomischer Sicht oft schwerwiegend und weitreichend. Die Untersuchung von Opfern häuslicher und sexueller Gewalt ist ein Schwerpunkt der rechtsmedizinischen Begutachtungstätigkeit. Der folgende Artikel beschreibt die Grundlagen und das Vorgehen bei der rechtsmedizinischen Untersuchung von Gewaltopfern.

Background: Megalin and cubilin bind and internalize the 25(OH)D 3 -DBP complex in the kidney. Once the complex is internalized, 25(OH)D 3 is released and activated to 1,25(OH)2D3 the ligand for the vitamin D receptor (VDR). Supporting the important role of cubilin in this process recent findings showed that cubilin deficiency results in decrease of 25(OH) D 3 and 1,25(OH) 2 D 3 plasma levels. Methods: Two hundred T1D patients and healthy controls (n=200) were genotyped for five polymorphisms (rs3740168, rs3740165, rs1801233, rs1801229 and rs2796835) within the cubilin gene. The polymorphisms were analyzed by RFLP or real time PCR. Statistic analyses were performed by using allele-wise and genotype-wise χ 2 testing by using BiAS software. A p-value < 0.05 was considered as significant. Results: We found that the genotype "AA" of the rs3740165 was more frequent in T1 D patients compared to healthy controls (26.7% vs. 5.1%, p = 4x × 10 -7 ). Nevertheless no association between the rs3740165 polymorphism and the 25(OH)D 3 or 1,25(OH) 2 D 3 plasma levels was found. No association with the other studied polymorphisms was observed. Conclusion: Thus our findings reveal a novel association of the cubilin rs3740165 polymorphism with type 1 diabetes. Nevertheless how exactly this polymorphism could increase the risk to develop type 1 diabetes is subject for further investigations.