Identification and determination of age of needle tracks in human skin (author's transl)]

Examination of enzymic activities and histochemical reactions on needle pricks can be used to determine the age of micro-injuries with sufficient exactness. Well preserved skin shows patterns of enzymes which also appear with other skin injuries and which were described in detail especially by Raekallio (1970, 1972). In autolytical changes of the skin the adenosinetriphosphatase-reaction is still reliable and can be successfully estimated. If one has sufficient experience it is possible to fairly exactly estimate the age of an injury within the first hour after the injury by preparation of the adenosinetriphosphatase-reaction. If the times of injections are known one frequently succeeds in determining the time of death by exactly determining the age of the injury. In legal expertises the histochemical reactions can rightly be regarded as useful indications of a certain age of the injury. But they do not allow an exact estimate "beyond a reasonable doubt".     

The significance of inner ear fluid (perilymph) in forensic medicine (author's transl)]

An original method for collecting the perilymph in the inner ear by chiselling the pyramid of the temporal bone is presented; From 300 to 350 mul of fluid may be obtained each time. Various types of determination were performed on 399 human cadavers. The alcohol level was tested in 140 cases, the ABO(H) group antigens were determined in 89 cases, the phenotypes of the gamma-globulin (1) group system in 152 cases, and the alpha1-antitrypsin (Pi) system in 18 cases. Determinations of the alcohol level in the perilymph has been confirmed to be useful, as they allow not only determination of the degree of intoxication in cadavers in an advanced state of decomposition, but also by comparing the alcohol concentration in the cerebrospinal fluid, the vitreous humour, and the blood, the phases of elimination and absorption of alcohol may be more precisely determined. It was also found that the perilymph is a good medium for the determination of the group antigens of the red blood-cells and the gamma-globulin system, the serum and the alpha1-antitrypsin enzyme. These data suggest that the method may be more widely used in various forensic medical tests.     

Quantitative investigation of the amino acid levels in putrefying liver (author's transl)]

To elucidate the post-mortem proteolysis we investigated the behaviour of the free amino acids in rotting liver homogenates by means of two-dimensional thin-layer chromatography and reflection densitometry. The post-mortem alterations of the amino acid levels are characterized mostly by a two-phase increase with maxima at the end of the first and after the third week. A few amino acids showed only little changes hardly above the physiological intra-cellular levels. Anaerobic rat experiments and experiences with antibiotic treatment give rise to the supposition that increasing amino acid concentrations indicate a predominance of proteolytic activities over aminoacid catabolism. In the beginning autoenzymes are prevalent, while afterwards bacterial proteases probably predominate. The transient regression about the second and thrid week is interpreted as the effect of a temporarily intensified amino acid degradation by foreign enzymes (maximal bacterial growth).     

Suicides in hospitals of Vienna (author's transl)]

An analysis of the autopsies ordered by the Viennese Forensic and Health Authorities between 1967 and 1976 has shown that 2.3% of all suicides were committed in hospitals. Two thirds of the 77 examined cases were carried out by males. Thirty-five patients were in stationary psychiatric treatment; their average age was 50.7 years. In all other kinds of hospitals 42 (mostly male) patients committed suicide at an average age of 65.3 years. Preferred methods of performance were jump and fall from height (44.1%) and hanging (40.3%). Rare methods used were one case of abdominal incisions (harakiri), one self-strangulation, and one case of suffociation in plastic bags. The act was usually accomplished early in the morning or in the late afternoon. Among the suicidal patients who were hospitalized because of organic diseases those with malignant neoplasms [18] and cardiovascular diseases [12] were predominant. Also taking the suicides outside hospitals into consideration the numerical ratio between natural deaths due to cancer and the suicides of cancer patients is about 1:1,000. Amont the suicides in psychiatric institutions schizophrenics [11] and endogenous depressives [7] were the most numerous. In 4 cases the suicide was preceded by acts of injury or homicide.     

Morphological findings in Zieve's syndrome (author's transl)]

The macroscopic and microscopic findings of a case of Zieve's syndrome are described (fatty liver, icterus, hyperlipemia and hemolytic anemia in chronic alcoholism). The outstanding macroscopic finding is milky turbidity of the blood in arterial and venous vascular channels as well as hepatomegaly and anaemia of internal organs. A prominent feature of the histological picture is the high-grade lipaemia of the large and small vessels (arteries and veins), capillary occlusions resembling fat embolism in all organs and severe diffuse fatty metamorphosis of the liver. Circulatory disorders and the cause of death are discussed.     

Delinquency under drug influence (author's transl)]

In delinquency, connected with alcohol, the immediate and acute effect of the substance is prominent, whereas in delinquency connected with drugs, one has to deal with chronic effects. The criteria for judging drunken offenders also stand as a model for judging the responsibility of the addicted offender for his crime. We consider: 1. the personality of the offender 2. the way, the amount and the point of time of the last intake of the drug 3. the potential dependence 4. the psychopathological state at the time of offense and at the time of examination 5. the kind of the offense itself. Most cases, which have to be examined, deal with indictable offenses, which were undertaken, in order to get new supply, i.e. "supply-offenes". These cases surmise, that the offender is physically addicted, that he knows about withdrawal symptoms from own experience, and that he committed the crime purely for securing his personal supply. We differentiate between direct "supply-offenses" (i.e. direct stealing by the addict himself) and indirect "supply-offenses" (i.e. mainly trading and commission business). For the latter offenses the state of consciousness and insight at the time of offense does not serve as a suitable criterion for judging the responsibility for the crime, since these offenders usually are not deprived of their drugs and therefore in a stable state of mind. Therefore the inner situation and the motivation for carrying out the crime has to be analysed carefully. For these indirect "supply-offenses" reduced responsibility for the offense has to be considered, whereas for direct "supply-offenses" a total lack of responsibility can be assumed.     

Acute lethal alcohol intoxication (author's transl)]

In 14,744 autopsy cases from an 18-year period 92 cases (of which 7 were ruled out because of decomposition were observed in which death was supposed to be due to direct acute alcoholic intoxication. In the police reports 81 persons were designated as chronic alcoholics or abusers of spirits. The blood alcohol level ranged between 2.04 and 4.92 o/oo. The cases studied were divided into two groups, one with low and the other with high lethal alcohol level. Fatty liver and cirrhosis were found with identical frequency in the two groups, whereas cardiac hypertrophy of obscure origin occurred markedly more often in the group with low lethal blood alcohol level. On the basis the possible mechanism of death in the cases with cardiac hypertrophy is discussed. Finally, the relation between the blood and urine alcohol concentrations observed in 72 cases is discussed. On the assumption that the water phase of the blood was 75 per cent of the total blood, death occurred in the persons without cardiac hypertrophy with fairly identical frequency either in the phase of absorption or the phase of elimination, whereas in the persons with cardiac hypertrophy death most often occurred in the phase of absorption. These statements should, however, be taken with some reservation, partly because the water phase of the blood may vary considerably post mortem (60-90 per cent) and partly because the urine alcohol concentration depends on serval variable factors.     

Mesothelioma of the septum interatriale (author's transl)]

Sudden death of a 21-year-old women. The cause of death was mesothelioma situated in the region of the interatrial septum that has been manifested since childhood as a complete heart block. Neither gravidity nor delivery led to the aggravation of her state of health. The cause of this heart lesion, which was the mentioned rare tumor, was discovered only during the autopsy.     

Post mortem determination of bromureides (author's transl)]

Concentrations of carbromal, carbromide and bromisoval are determined in blood, urine, brain, kidney and muscle taken at autopsy from 41 fatal cases after overdosage of bromureides. In addition values of total bromine in blood are presented. Contents of total bromine can only lead to the deduction that a chronical abuse of bromureides is existent or not. Concentrations of bromureides and carbromide show a wide range according to the different time between taking the drug and death particularly in cases of pure carbromal intoxications which sometimes cause death after several days. In such cases quantitative determination of carbromide, a pharmacologically active metabolite of carbromal, is the only way to prove an acute carbromal intoxication. Especially in cases of additional foreign substances death may occur in early the phase of poisoning. Bromureides decompose post mortem by putrefaction a high degree so that the condition of the cadaver is important. Brain tissue is the most usable material for examination but other organs, particularly muscle and kidney, can be analysed with success. For differential diagnosis fatal cases are presented which were not caused by drug intake.     

Examinations to phenomenon of shock-lung (author's transl)]

The pathogenesis of shock lung as well as the success of therapy in this condition was studied in 79 cases of extrathoracic trauma. The water-, hemoglobin-, and DNA contents of the lungs were measured in order to determine the extent of edema, the rate of perfusion, and proliferation. The cases were divided into two groups according to whether they had or had not received medical therapy before death. The data from these two groups were compared using statistical methods in which time of survival was especially taken into account. The fluid balance, pO2, pCO2, central venous pressure, pH of the serum, total serum protein and serum creatinine were also studied in these cases. Results of the study are as follows. Three phases of the posttraumatic syndrome of shock-lung could be distinguished: phase I (initial phase): blood perfusion is increased, edema is beginning to form, and medical treatment has not yet begun. Phase II (early phase = sydrome of early respiratory failure): pulmonary edema is developing rapidly while perfusion is decreasing. Phase III (late phase = syndrome of late respiratory failure): proliferative changes predominante and the edema is still increasing. The mean weight of the lungs was 397 g (s = 170) in phase I, 774 G (S = 361) In phase II, and 1124 g (s = 310) in phase III. The survival times correlated significantly and positively with the amount of water and DNS in the lungs and significantly and negatively to the amount of hemoglobin in the lungs. Thus, increasing pulmonary edema and increasing proliferative changes occurred with decreasing pulmonary perfusion. This correlation was even noted in groups of patients who had not received medical treatment and whose survival times were short. In treated cases, the fluid balance was significantly and negatively correlated to the total serum protein.     

Exceptional suicide of a physician (author's transl)]

A 57 years old psychiatrist committed suicide through insufflation of powder from a chemical fire extinguisher his respiratory and gastrointestinal tract. Death was due not to mechanically induced asphyxia but to asystolia. The latter disturbance is explained as a vagal reaction to trauma because of the characteristic position of the corpse at the scene and because the victim did not exhibit any signs of gas or foreign body embolism. A further point of interest in the context of trauma mechanism, is the absence of significant disruptions in spite of the high pressure (10-12 atu) developed by the extinguisher. No conclusive interpretation can be given about the psychological mechanisms behind this suicidal act. On the other side the modality of the procedure used by the victim became manifest already a few months before the critical act.     

Mechanical tolerance of tentorium cerebelli (author's transl)]

In some cases of accidents primary traumatic brain stem hemorrhages are seen in conjunction with lesions of the tentorium cerebelli. In order to decide, whether accelerations of the infra- or supratentorial brain tissue are actually capable of causing tentorium lesions, burst and teartests of tentorium tissue were conducted. The mean dynamic biaxial tearing force was found to be about 4 bar. This value supports the hypothesis that a main injury causing factor of the tentorium in cases without skull fracture could be the relative motion between the tentorium and the brain hemispheres. The mass of the cerebellum however seems to be insufficient to cause such injury producing deceleration forces on the tentorium.     

Frequency of positive diazepam-screening in post-mortem examinations (author's transl)]

The post-mortem blood specimens of 389 forensic autopsies were analyzed for diazepam. The age of the cases investigated was above 10 years and the survival time was less than 12 hours. Eighteen samples corresponding to 4.6% were found to be diazepam-positive. These 18 samples were distributed equally between men and women. The proportion of diazepam-positive samples was increased in the groups of suicide and poisoning (alcohol and opiates). The association between diazepam intake and poisoning was statistically highly significant. No correlation was found between diazepam intake and age. Alcohol was found to occur significantly more often in the group of the diazepam positive cases as compared to the diazepam negative group.     

Impairment of performance by alcohol and diazepam (author's transl)]

An investigation was carried out on the effect of the intake of diazepam and alcohol on simple performance tests. The combined administration of diazepam and alcohol led to an increase of the plasma diazepam concentration as compared to that obtained after diazepam without alcohol. Furthermore, after combined intake of diazepam and alcohol a decrease of performance was observed, that was significantly higher, than the effects obtained after either alcohol or diazepam alone. This impairment was especially noticeable duirng the first hour of the experiment, i.e. until the plateau of the diazepam plasma concentration was reached, while afterwards a correlation between diazepam plasma concentration and impairment of performance could not be established. The relevance of these findings for the interpretation of diazepam plasma concentrations in relation to the impairment of performance are discussed.     

Morphological findings after tracheotomy and laryngeal intubation (author's transl)]

4 fatal cases after tracheotomy and 35 cases after endotracheal anaesthesia were examined taking pathomorphological aspects into consideration. In long-period intubation mucous membrane necroses occurred as of the 4th day. After 6 days' intubation skeletizations of the tracheal rings were established in each case. Infections of the decubial ulcers and errosion haemorrhages from the necrotically altered tracheal wall were frequent complications. Faulty intubation of the oesophagus and the right bronchus, aspirations and reflex-related circulatory failure during intubation as well as hypoxic damage as a result of the windpipe opening being impaired are discussed from the morphological point of view.     

Exhumation for suspected poisoning--reticulum cell sarcoma (author's transl)]

A 57-year-old woman showed somnolence, extreme stiffness of the neck and atypical CSF findings which led to her death within a few days. During legacy controversy the possibility of poisoning was considered. The post mortem, pathological and toxological examinations of the exhumed corpse permitted the diagnosis of reticulum cell sarcoma 16 months after death. Such a diagnosis 16 months after death has, to our knowledge, not previously been reported.