Domestic accident or child abuse?

While playing, a 33/4-year-old girl was hiding in a tumble dryer, which had been running before and started the drying process with rotation of the drum again after the girl had climbed into the machine and shut the door. The child suffered multiple haematomas, especially on the back and the lower arms, as well as second-degree burns on body regions not covered by the clothing. The injury pattern was consistent with the properties of the appliance, and the initial suspicion that the child had been physically abused could not be maintained.     

Accidental autoerotic death by volatile substance abuse or nonsexually motivated accidents?

In contrast to typical autoerotic fatalities, when death is due to asphyxia mostly by mechanical compression of the neck, atypical autoerotic accidental deaths (AADs) involve sexual self-stimulation by other means such as electrocution or inhalation of chemical agents. Especially in lethal cases of volatile substance abuse (VSA), a differentiation between suicide or sexually or nonsexually motivated accident is often complicated in practical casework. Considering the small number of AADs involving chemical substance abuse reported in the literature, the number of unreported cases seems to be very high. We report about 5 lethal cases of VSA; analysis was performed using headspace solid-phase microextraction (HS-SPME) and gas chromatography-mass spectrometry (GC/MS). When headspace sampling is not performed at autopsy, the analysis of volatile substances can be very complicated. In 2 cases, an AAD was diagnosed considering findings at the scene, reconstruction of the event, and discussion of the circumstances of the death. These findings demonstrate the importance of VSA in atypical autoerotic asphyxia. Therefore, in cases of suspected lethal inhalational intoxications, as a matter of principle, headspace asservation should be performed at autopsy and an autoerotic motivational background should be taken into consideration for differential diagnosis.     

End of life decisions and pregnant women: do pregnant women have the right to refuse life preserving medical treatment? A comparative study

In this article the practice of end of life decisions is applied to pregnant women. This is not an easy task as shown by the extensive case law and literature on the subject. The main conclusion of the article is that the pregnant woman's wishes should always be respected whatever the consequences for the foetus may be. Another position would unjustly sacrifice the woman's fundamental rights to bodily integrity and self-determination for the benefit of a non-person. The result is repeated in the situation where the woman is found to be incompetent or brain dead.     

Vaginorectal impalement injury in a 2-year-old child--caused by sexual abuse or an accident?

Anogenital impalement injuries are rarely encountered in clinical or forensic practice. If seen in children and if incurred under suspect circumstances, sexual abuse must be considered in the differential diagnosis. Here we describe the case of a 2-year-old girl admitted to hospital with a vaginorectal impalement injury. According to the girl's parents, she had slipped in the bathroom and fallen onto the handle of an upright toilet bowl brush. Since a second slight anal injury was present, the parents' account appeared inconsistent. Therefore, physicians from the Institute of Legal Medicine were consulted to investigate the possibility of underlying sexual abuse. Because they could not rule out that the injuries could have been caused by sexual abuse, they recommended having the police immediately examine the site of the purported accident for evidence. The police and forensic investigations, however, verified the parents' account of an accidental injury. Thus, in this case, the initiation of a police inquiry, which is not compulsory in Germany even when sexual abuse is strongly suspected, led to the exoneration of the father.     

Unusual infant death: dog attack or postmortem mutilation after child abuse?

An unusual form of fatal child abuse is reported in which investigations by the police and the medical examiner were able to distinguish blunt force head trauma followed by postmortem dismemberment from a fatal dog attack. A discussion of the approaches used to ascertain the correct diagnosis is presented, as well as an overview of dog attacks on humans.     

Subject for discussion: is sexual abuse of a sleeping person possible or fantasy or simulated?

There have been reports of sexual acts on sleeping women since ancient times. Whether this is possible at all has been under controversial discussion by lawyers and lay people. The paper presents two cases of non-consenting penetrating intercourse with sleeping women and various legal and expert opinions. The authors discuss the possible influence of drugs and alcohol.     

An exploratory study of women arrested for intimate partner violence: violent women or violent resistance?

With the advent of mandatory and pro-arrest laws for incidents of intimate partner violence, there has been an increase in the number of women arrested for domestic violence. Several explanations are posed in the literature that attempt to explain such a rise, including the hypothesis that women are being arrested not for offensive violence but rather for defensive violence. Few studies, however, have used empirical data to support such arguments. This exploratory study examines the characteristics of women arrested for intimate personal violence. Particular attention is paid to women arrested with their partner (i.e., dual arrestees) and the contextual characteristics of dual arrestee incidents. Important differences are uncovered in the context and consequences of arrest for dual arrestees (n = 21) compared to women arrested alone as the offender (n = 49). Implications of these findings and further research directions are discussed.     

Subjective effect of September 11, 2001 among pregnant women: is cumulative history of interpersonal violence important?

Prior history of trauma may sensitize individuals to subsequent trauma, including terrorist attacks. Using a convenience sample of secondary, cross-sectional data, pregnant women were grouped based on lifetime interpersonal violence history. Cumulative risk theory was used to evaluate the association of lifetime interpersonal violence history and subjective impact of the September 11, 2001 (9/11) terrorists attacks. Using hierarchical linear regression, cumulative risk theory was partially supported. Women with a history of only one type of interpfersonal violence reported greater effect of 9/11 than did women without a history, but women with both types of violence did not report a greater effect of 9/11 compared to women endorsing history of one type. These data corroborate the literature in that level of exposure to terrorist-related trauma predicts subjective reaction to the attacks. Future research with a larger sample and standardized instruments is warranted.     

Is schizoid personality a forerunner of homicidal or suicidal behavior?: a case study

The authors believe that a relationship exists between schizoid personality disorder and violent acts. The following case study is presented to contemplate such a possible relationship. There is a paucity of research on this topic. The authors suggest that further research closely examine the relationship between violent behavior and those character traits associated with schizoid personality disorder. If such a relationship is found, these character traits could be integrated with other risk factors known to predict violence.     

An unusual death by transcranial stab wound: homicide or suicide?

Penetrating stab wounds of the brain are uncommonly seen in modern times and occur almost exclusively in homicides. We report an unusual death by self-stabbing. A 24-year-old man was found dead at home, the handle of a kitchen knife protruding from his forehead. Data such as the psychiatric history of the victim, the multiplicity and site of wounds, the implement used, the presence of hesitation, and defense wounds were studied to elucidate the manner of death, and the suicidal nature of the event was established after police investigation. Atypical injuries require a careful forensic investigation, and medico-legal aspects of the differentiation between homicide and suicide are discussed in this particular case. A review of the literature revealed few cases of suicidal transcranial stab wounds.