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.     

When silence threatens safety: lessons from the first Canberra Hospital neurosurgical inquiry

Despite widespread institutional and professional support, the recommendations of the Bristol Royal Infirmary Inquiry may be insufficient to reduce patient risk from impaired senior medical practitioners. Using the First Inquiry into Neurosurgical Services at the Canberra Hospital as a case study, this article argues that the Bristol-type recommendations--which emphasise reformulation of clinical governance structures, including early reporting of "sentinel events" and compulsory clinical audits--will be ineffective without a reformed institutional ethos that encourages open transparency and respect for those committed to such processes. Such reformulation may need to commence in medical education and involve new strategies including the use of portable digital technology to facilitate self-assessment of performance and immediate reporting of adverse incidents.     

Radiologically determined DMF index variations for forensic age estimation of young adults

The eruption and mineralization of third molars are the main criteria for dental age estimation of living people involved in criminal proceedings. Since the development of third molars is usually completed by the age of 19 or 20 years, this feature cannot be used to ascertain whether a person has attained the forensically relevant age of 21 years. This study examined whether the DMFT index or the third molar DFT index could supply reliable information enabling conclusions to be drawn about whether a person has reached the age of 21. To this end, 650 conventional orthopantomograms of German subjects aged 18 to 30 years were evaluated. The DMF index variations considered were found to be unsuitable for determining whether a person is over 21 because they displayed a weak correlation with age and considerable individual scatter. A high indicative value can only be attributed to a third molar DFT index of 4, although this is rarely observed in the relevant age group. An X-ray examination of the medial clavicular epiphyseal cartilage is, therefore, strongly recommended when assessing whether a person has attained 21 years of age.     

Medicolegal aspects of witnessed suicide due to gunshot to the head. II. Legal medicine aspects and examination of the firing hand

The second part of the paper on suicides by gunshots to the head in the presence of witnesses focuses on relevant morphological autopsy findings such as entrance site, signs of close range or contact shots, bullet path etc. and also discusses selected aspects of ascertaining gunshot residues. For the identification of the shooter an integral medicolegal assessment of all the facts including the investigation results and the autopsy findings is essential. However, the morphological findings alone do not allow safe diagnosis, as for example in a homicide the temporal region, which was affected in all our cases, may have been deliberately chosen by the perpetrator as a localization typical of suicide. Thus methods to ascertain gunshot residues on the firing hand (by means of adhesive films and the polyvinyl-alcohol collection method--PVAL) are of great practical importance. In seven cases adhesive films and/or the polyvinyl-alcohol collection method were used. In one case the gunshot residues (GSR) were analysed by means of tape lifts and subsequent scanning electron microscopy (SEM). It was found that especially the combined application of topographical (adhesive tape/PVAL) and cumulative (SEM) methods allowed for the doubtless identification of the shooter, thus usually confirming the suicide. By the example of one case it is demonstrated that without the immediate collection of evidence at the scene objective reconstruction of the event becomes impossible. On the basis of the reported cases recommendations are finally given for a differentiated approach in the medicolegal evaluation of alleged witnessed suicide by gunshot (to the head).     

Area-specific increased density of mu-opioid receptor immunoreactive neurons in the cerebral cortex of drug-related fatalities

In animal experiments and in cell culture, chronic morphine treatment has been followed by "up-regulation" as well as "down-regulation" of the mu-opioid receptor (OR) number. The present postmortem morphometric study of morphine-related fatalities of drug-addicts (n=13, 20-35 years old, with blood unconjugated morphine levels from 27.1 ng/ml to 458 ng/ml, m.v. 198.5 ng/ml) versus a non-addicted control group (n=13, 10-44 years old) was intended to examine, whether chronic opiate exposure affects the numerical density of mu-OR expressing neurons in the human neocortex (areas 11, 24 and 25 according to Brodmann). For the immunohistochemical procedure, vibratome sections (100 microm) were incubated with a monoclonal antibody against the mu-OR, diluted 1:100, and immunolabelled sites were visualized using an immunoperoxidase protocol. The numerical densities of OR immunoreactive neuronal profiles and Nissl-stained central profiles were assessed morphometrically (camera lucida-drawings). In both groups, the anti-mu-OR-immunoreactivity was mainly localized in pyramidal neurons of layers (L) II/III and V and in multiform neurons of L VI. In the areas 24 and 25, the density of the immunoreactive neuronal profiles did not display a significant difference between the two examined groups. In the area 11, however, the number of immunolabelled neuronal profiles amounted to 2777+/-206 mm(3) in the drug-related fatalities and to 2320+/-124 mm(3) in the control group and thus was significantly increased.     

To leave or to stay?: Battered women's concern for vulnerable pets

Consistent with previous research, almost half of a sample of 41 pet-owning battered women reported that their partners had threatened or actually harmed their pets, and over a fourth reported that concern for their pets had affected their decisions about leaving or staying with the batterer. Differences between rural and urban women were not significant, although higher proportions of rural than urban women reported that their partners had threatened or harmed their pets and that concern for their pets had affected their decisions. For the sample as a whole, logistic regression analyses showed that women whose pets had been threatened or harmed were significantly more likely to report that concern for their pets had affected their decisions about leaving or staying. The findings suggest that service providers should inquire about battered women's concern for their pets and should include arrangements for animals in safety planning.     

Analysis of 1989-1999 homicide crimes in the catchment area of the Bonn Institute of Forensic Medicine with reference to selected aspects

195 cases of homicide, grouped according to juridical assessment, were retrospectively analysed with regard to individual characteristics of perpetrators and victims, circumstances, and mode of commitment. The involvement of underage victims and perpetrators as well as differences between the urban and rural areas studied were taken into special consideration. To summarise, the majority of the offences studied was carried out by a male perpetrator with a mean age of 35 years driven by personal motives or greed in his immediate vicinity and affected family members or close acquaintances. The fatal injuries were mainly attributable to sharp or blunt force. With regard to killings of children, a higher prevalence of female victims and male assailants, emotional motives and an even higher importance of the social vicinity were found. Particularly in victims younger 12 years of age, manual modes of commitment without application of any tools were predominantly encountered. The comparison of urban and rural areas revealed a higher homicide rate in municipal areas especially of offences with a loose relationship between victims and assailants (greed, sexual assault). In contrast, rural areas exhibited higher rates of bodily harm with fatal consequences as well as offences by highly intoxicated assailants.     

Numerical density of mu opioid receptor expressing neurons in the frontal cortex of drug related fatalities

In animal and cell culture experiments, chronic morphine treatment has been followed by 'up'- as well as 'down-regulation' of the mu opioid receptor (mu OR) number. The present postmortem morphometric study of morphine-related fatalities of drug addicts (n=12, and 22-35 years old, with blood unconjugated morphine levels from 27.1 to 458 ng/ml, m.v. 198.5 ng/ml) versus a non-addicted control group (n=13 and 10-44 years old) was intended to examine whether chronic opiate exposure affects the numerical density of mu OR expressing neurons in the human neocortex (area 10 according to Brodmann). For the immunohistochemical procedure, thick (100 microm) vibratome sections were incubated with a monoclonal antibody against the mu OR [Arvidsson et al., J. Neurosci. 15 (1995) 3328] and immunoreactive sites were visualized using an immunoperoxidase protocol. The numerical densities of mu OR-expressing and Nissl-stained neurons were assessed morphometrically (camera lucida-drawings). In both collectives, the anti-mu OR immunoreactivity was mainly found in pyramidal neurons of layers (L) II/III and V and in multiform neurons of L VI. In the drug-related fatalities and the control group, the density of neurons expressing mu OR protein was similar, amounting for 2698 +/- 153 and 2688 +/- 172/mm(3), respectively. These findings extend the binding studies of opioid ligands in postmortem brains of heroin addicts [Gabilondo et al., Psychopharmacology 115 (1994) 135] revealing similar receptor densities and affinities by showing no difference in the density of mu OR-positive neurons.     

Brazilian population database for the 13 STR loci of the AmpFlSTR Profiler Plus and Cofiler multiplex kits

Allele frequencies for the 13 STR core loci (D3S1358, VWA, FGA, D8S1179, D21S11, D18S51, D5S818, D13S317, D7S820, CSF1PO, TPOX, THO1 and D16S539) included in the AmpFlSTR((R)) Profiler Plus and AmpFlSTR((R)) Cofiler kits were obtained for a sample of 700-800 genetically unrelated Brazilians. The expected performance of these loci for personal identification and paternity testing in the Brazilian population was estimated.