About morphological findings in fatal railway collisions

The autopsy findings in fatal cases of railway collisions of the Bonn Institute of Legal Medicine in 1992-1999 were investigated and compared to the statements in the investigation files of the public prosecutor with regard to classification as accident or suicide as well as with regard to type and speed of collision. Of the 38 deaths, 10 were hit in an upright position, 11 fatal collisions affected persons lying outside the track and 13 were hit and overrun lying inside the track. According to the investigation classification 21 persons committed suicide (56%), while 10 died in an accident (26%). Our survey confirmed the leading role of being over-rolled in a lying position as an indication for suicides, while in accidents the upright hit was most important. With exception of the persons primarily affected between the rails in upright position and over-rolled consecutively an unequivocal assignment of injury patterns to the hit categories was possible. In cases of persons being primarily over-rolled in a lying position especially the criteria (i) opening of body cavities, (ii) organ injuries and (iii) loss of parts of the body allowed for careful conclusion on hit, respectively, overrunning speed.     

Applicability of succinylmonocholine as a marker for succinylcholine administration--comparative analysis of samples from a fatal succinylcholine-intoxication versus postmortem control specimens

Doubts concerning the applicability of succinylmonocholine (SMC) as a succinylcholine (SUX) marker have been issued. A comparative analysis of previously discussed tissues, i.e. brain, liver and kidney, was conducted to further elucidate this question by searching for diagnostically useful differences in analyte content in samples of SUX- versus non-SUX-associated fatalities. Furthermore, possible advantages of vitreous humor as a novel and promising target matrix for SUX analytics were assessed. Sample material of SUX-negative controls as well as the fatal SUX-intoxication was derived from frozen archive material and current autopsies. Samples were analyzed according to a modified protocol of a previously published and validated method employing ion-pairing solid-phase extraction and subsequent HPLC-MS/MS analysis. Standard addition was employed for quantification as well as an estimation of the analytical limits of the method. In all tested matrices, the method was proven to be sufficiently sensitive for the intended application. No indication of native SMC was found in controls of fresh tissues, nor in fresh or frozen vitreous humor. However, most of the samples were found to be positive for a previously reported interference with SMC's main ion transition, thereby falsely suggesting an SMC content of up to 139 ng/g, 126 ng/g, 165 ng/g and 93 ng/ml in brain, liver, kidney and vitreous humor, respectively. Contrasting the results for fresh sample material, SMC was detectable in some of the initially non-putrefied liver samples after long-term storage, as well as in massively decomposed SUX-negative control bodies. In this context, a microbial origin of the analyte may be assumed. All tissues as well as the vitreous humor of the fatal SUX-intoxication were negative for SUX and SMC. Just like serum, tissue and vitreous humor samples therefore do not allow a reliable diagnosis of a SUX-intoxication: in tissues this is due to the pronounced instability of both target analytes in these esterase-containing matrices, for vitreous humor an additional reason could be their insufficient incorporation into this medium.     

Fall from height--surprising autopsy diagnosis in primarily unclear initial situations

External post-mortem examination and first police assessments are often not consistent with subsequent autopsy results. This is all the more surprising the more serious the injuries found at autopsy are. Such discrepancies result especially from an absence of gross external injuries, as demonstrated by four examples. A 42-year-old, externally uninjured male was found at night time in a helpless condition in the street and died in spite of resuscitation. Autopsy showed severe polytrauma with traumatic brain injury and lesions of the thoracic and abdominal organs. A jump from the third floor was identified as the cause. At dawn, a twenty-year-old male was found dead on the grounds of the adjacent house. Because of the blood-covered head the police assumed a traumatic head injury by strike impact. The external examination revealed only abrasions on the forehead and to a minor extent on the back. At autopsy a midfacial fracture, a trauma of the thorax and abdomen and fractures of the spine and pelvis were detected. Afterwards investigations showed that the man, intoxicated by alcohol, had fallen from the flat roof of a multistoried house. A 77-year-old man was found unconscious on his terrace at day time; a cerebral seizure was assumed. He was transferred to emergency care where he died. The corpse was externally inconspicuous. Autopsy revealed serious traumatic injuries of the brain, thorax, abdomen and pelvis, which could be explained by a fall from the balcony. A 47-year-old homeless person without any external injuries was found dead in a barn. An alcohol intoxication was assumed. At autopsy severe injuries of the brain and cervical spine were found which were the result of a fall from a height of 5 m. Conclusion: On the basis of an external post-mortem examination alone gross blunt force trauma cannot be reliably excluded.     

Cyanide fatalities: case studies of four suicides and one homicide

Deaths due to cyanide poisoning are relatively rare, largely owing to the restricted availability of cyanide. Nevertheless, the authors report five cases of cyanide fatalities occurring within a few months. Cyanide is one of the most rapidly acting poisons known and is still used for suicide and homicide. The discussion focuses on the circumstances, metabolic changes, pathophysiology, blood levels, diagnosis, and management of cyanide poisoning.     

Thoracic stab wound caused by a grilling scewer with defomration of the tool

Injuries by meat- or barbecue-skewers are rarely relevant as cause of death. Besides accidental injuries they are used as coincidental tools in capital crimes. Skewers are non-typical stabbing tools of pointed-squared structure, which need considerable force to penetrate the skin. The authors report on a 42-year-old man's fatal thorax stab injury, which he sustained during a barbecue and which stretched from the left mamilla into the back right shoulder tissue. Death was caused by exanguination following stabbing through the superior vena cava. At issue was the question what amount of force was necessary to inflict the wound. Based on the deformation of the stabbing tool, as a result of a material-technical expertise, compressive load application in longitudinal direction and a stabbing force of between 120 to 665 N were to be assumed. Furthermore, in addition to the features of a non-typical tool, the autopsy findings allowed to conclude a powerful stabbing.     

Homicidal alcoholic intoxation versus manual neck compression

A case of homicide involving a 49-year-old man is reported. In the course of a booze-up he was forced to excessive consumption of alcohol and was pushed back into a sofa by repeated grasping his neck which finally left him dead. The postmortem examination revealed a small abrasion in the right mandibular region, a contusion of the subcutaneous tissue above the left clavicle, a haemorrhage in the deep muscles of the neck at the right side of the cervical spine, a fatty tissue haemorrhage between the left cornus of hyoid and thyroid cartilage as well as petechiae of the eyelids and conjunctivae. The blood alcohol concentration amounted to 4.00@1000, the urine alcohol concentration to 5.26@1000. Thus, a manual strangulation of the neck versus a lethal alcohol intoxication had to be taken into consideration as cause of death. The morphological findings of the postmortem examination and the pathophysiological concepts of the underlying mechanisms of death in manual strangulation versus lethal alcohol intoxication are discussed with regard to their significance for the juridical assessment.     

Complex brain malformation as a rare cause of neonatal death

A dead female neonate was brought to a children's hospital by the mother. The MRI scan suggested a malformation of the brain. Because of the other circumstances of the case (the mother left the hospital unauthorizedly), a forensic autopsy was ordered, in the course of which the brain was removed while the head was totally immersed in water. This method, which was introduced by Prahlow et al., helps to obtain intact brain specimens without interfering with the necessary medicolegal preparations to determine whether the child was born alive. Neuropathological examinations classified the cerebral malformation as (lethal) lissencephaly. Further investigations showed that the mother had lived in Germany without a residence permit.