Delayed pericardial tamponade following a stab wound to a branch of the right coronary artery

A 45-year-old man was attacked with a knife and suffered multiple stab wounds to the chest and abdomen. After surgical treatment and hospitalization for 9 days he was discharged in a stable condition. The following day he was found dead in his apartment. The autopsy revealed a pericardial tamponade caused by acute bleeding from an injured branch of the right coronary artery. This case shows that life-threatening late complications in patients with penetrating cardiac wounds may occur despite an initially uneventful course.     

Not enough help for themselves--the risk of physicians to commit suicide

Physicians seem unwilling to deal with their own suicidal problems professionally. Suicide is a repressed topic. According to international studies, medical students and physicians are clearly over-represented among suicide victims. Committing suicide stands in sharp contrast to the positive image physicians enjoy as competent, strong helpers transmitting positive energy. Various studies and meta-analyses show that physicians use knowledge specific to their profession and are therefore "more successful" than the general population in committing suicide. Moreover, the data reveal a number of risk factors specifically correlating with medical practice. This is confirmed by an increased number of suicides during medical training and professional life in comparison with the general population. Gender-specific analyses show an even higher suicide risk for female physicians. In this context it cannot be excluded that out of "professional respect" cardiovascular causes of death are sometimes falsely documented in death certificates instead of suicide. Despite their special education, physicians are not very good at diagnosing their own emotional disorders and asking colleagues for adequate professional help. They rather tend to camouflage their own psychological problems also because they are afraid of occupational and personal discrimination.     

Survived crossbow injuries

The Hamburg University Institute of Legal Medicine presents 2 cases of injuries of crossbow arrows where the patients survived. Crossbows are used nowadays as sports and hunting weapons. They are freely obtainable, and since people without practice can shoot them, there are constant injuries and fatal cases. Crossbow arrows have a high penetration force and can even pierce bone. Depending on the tip of the arrow used, they bore or cut through tissue, here damage to the tissue being restricted to the direct surroundings. Due to the elasticity of the tissue, the arrow shaft in the wound track may have the effect of an incomplete tamponade so that major hemorrhaging is prevented. In this condition, the injured person may be conscious and capacitated. From the medical viewpoint, crossbow arrows should therefore be invariably left in the wound, secured against displacement during transport, and only removed in the hospital.     

Intramuscular bleeding in deaths from an internal cause: forensically significant differential diagnosis between external trauma and hemorrhages occurring during agony

Five cases of death from an internal cause are described in which bleeding into the muscles of the neck, the region of the shoulder girdle, the back of the thorax and partly the arms occurred during agony. As the cause of death was unclear at first and a violent crime could not be ruled out, a forensic autopsy was ordered in the course of which hemorrhages were detected which raised the differential diagnostic question whether extravasation might have been caused by an impact of blunt force. However, thorough investigation of the macroscopic and especially the microscopic structure of the lesions provided clear evidence that all the hemorrhages were due to internal causes. The pattern of these muscular lesions suggests intensified breathing with dyspnea leading to ruptures of the accessory respiratory muscles. Intramuscular bleedings of this type are a well-known phenomenon in legal medicine in connection with death by drowning, but have not been described in the medicolegal literature in cases of natural death from an internal cause so far.     

Isolated peliosis of the spleen: report of 2 autopsy cases

Isolated peliosis of the spleen, characterized by the gross appearance of multiple cystlike, blood-filled cavities on cut surfaces of the organ, is a very rare pathologic entity that has been reported in 33 cases to date. We present 2 additional cases of isolated peliosis of the spleen observed at autopsy and confirmed by histology. In both cases investigated, cirrhosis of the liver was present. We hypothesize that local microcirculatory disturbances manifesting under altered local intravascular pressure conditions in the spleen may, at least to a certain degree, be responsible for the peliosis-associated vascular lesions. For the forensic pathologist, isolated peliosis of the spleen represents more than just another morphologic curiosity. The significance of peliosis lienalis lies in the potential of (1) overlooking the correct diagnosis as the cause of a spontaneous splenic rupture with intraabdominal hemorrhage, thus leading to the false conclusion of a violent death; and (2) misinterpreting the macromorphological appearance of this rare disease, also in the absence of splenic rupture, as a result of blunt force trauma.     

Preparation of degraded human DNA under controlled conditions

DNA typing through analysis of short tandem repeats (STRs) and mitochondrial DNA (mtDNA) by means of the polymerase chain reaction (PCR) and sequencing are the common methods for the forensic identification of persons and reconstruction of kinship, especially when skeletal human remains have to be analyzed. Furthermore, samples typically found at crime scenes may be both quantitatively and qualitatively inadequate since they may contain very scarce and often degraded DNA due to exposure to heat, light, humidity, and microorganisms. In order to improve the performance of STR typing technology in those cases where DNA availability is limited, it would be desirable to have a source of degraded DNA with known properties. For this purpose, we have developed a method to prepare artificially degraded DNA under controlled conditions. By treatment of genomic DNA with sonication and DNAse I we have produced DNA fragments within a defined range of lengths. STR typing of this degraded DNA with a commercially available multiplex kit could only produce partial profiles as indicated by the absence of STR alleles with sizes >200 bp. This artificially degraded DNA can be used for the improvement and standardization of STR typing protocols when only highly degraded DNA is available for analysis.     

Is Small Still Flexible? An Evaluation of Recent Trends in Danish Politics

How has Denmark been able to adjust its economic and industrial policies in an era of major changes in the international economy? The article gives a survey of the last 10 years, especially more recent years. Before 1986 wage policy and public-expenditure policy were dominant. Since then they have been supplemented by a new structural policy to increase the level of technology, to improve education and research and to change the composition of Danish exports as far as products and markets are concerned. The adjustment of policies has taken place in a stable multi-centred political system. The process has been characterized by institutionalized campaigning, moulding of interests and mobilization of compromises and mutual understanding. The capacity for flexible adjustment seems to originate from the stability of the political system. Likewise, uncertainty and instability seem to weaken the capacity for political flexibility. During the last two years the transformation of the elite consensus into state programmes and administrative decision-making has been hampered and the whole structural policy approach has been challenged by a neoliberal alternative. This is mainly due to an extraordinary parliamentary stalemate in a situation of extreme minority parliamentarism.