Suicidal shot in the mouth with an unmodified blank cartridge pistol

In the medicolegal literature reports of suicides with weapons designed for self-defence, especially gas pistols, are rare. We report on a suicide of a 54-year-old woman who fired a fatal shot in her mouth with an unmanipulated blank cartridge pistol, make R?hm RG 8, calibre 8 mm. The autopsy findings (lips and mucosa of the buccal vestibule without injuries, but extensive lesions of the tongue and the middle and rear third of the smooth palate) suggest that the shot was fired - as observed by a witness - with the barrel of the weapon inside the oral cavity. Both macroscopic inspection and histological investigations excluded the possibility that death was caused by an injury of the brain, in particular the brain stem. The immediate cause of death was deep aspiration of chyme with concurrent aspiration of blood.     

Cocaine-associated abscesses with lethal sepsis after splenic infarction in an 17-year-old woman

Well known complications related to cocaine use are myocardial insufficiency, myocardial infarction, myocarditis, aortic dissection, neurologic damages, ischemic colitis, thrombotic phenomenons, renal infarction and acute liver failure. Cases of splenic infarctions related to cocaine use are extremely rare. A 17-year-old drug addict was found by her boy-friend liveless in her bed. She was well known using cocaine since years. Autopsy revealed multiple splenic infarctions with secondary mixed bacterial infection and abscesses. Petechial bleedings were found and microabscesses in the myocardium, the meninges and the kidneys. The absolutely rare bacterial infection of the cocaine-associated splenic infarction leads to sepsis with lethal course.     

Multiple homicides--forensic and criminologic aspects

The interpretation of medicolegal findings in homicide is an important tool of case profiling (so-called "operative case analysis"). In 17 cases of "multiple homicides" involving 22 offenders (21 males, 1 female; mean age 33 years) and 45 victims (21 males, 24 females; mean age 35 years; 41 fatalities, 4 survivors), the autopsy reports and the prosecution authorities' files were retrospectively analysed with regard to individual characteristics of perpetrators and victims, circumstances, and mode of commitment in order to comprehensively characterise relevant forensic and criminologic aspects. 31 victims were found to belong to the close social environment of the perpetrator, and 32 killings were committed in the victim's, perpetrator's or the joint flat. The main motives included greed (n = 7), personal conflicts (n = 5) and concealing of a crime (n = 9). The relevant injuries were attributable to gunshot wounds (n = 13), sharp force (n = 11), blunt force (n = 3), ligature strangulation (n = 3), smothering (n = 6), fire/carbon monoxide (n = 2) and combined impacts (n = 7). In 12 victims, defense injuries were found. The blood alcohol concentration exceeded 1.5 g/l in 5 victims. In 5 offenders, a psychiatric impairment of juridical responsibility was assessed (and 20 German criminal code, n = 1, psychosis; and 21 German criminal code, n = 4; acute alcohol intoxication). As far as data were available, 16 crimes were judged as murder, 12 as manslaughter and one as physical injury with fatal outcome.     

Practical application of the Injury Severity Score (ISS) in expert forensic testimony

The retrospective analysis of the autopsy records of 50 homicides showed that the Injury Severity Score (ISS), a numerical scoring system initially developed to quantify the severity of injuries sustained in road traffic accidents, can also be useful for objectively describing and ranking the overall severity of trauma with regard to forensic issues. The present case report illustrates to what extent the ISS can help to assess the contribution of each assailant in homicides committed by several perpetrators. In the case presented the court was convinced that one perpetrator had inflicted four deep stab wounds to the victim's face (each with bony lesions), 2 stabs to the chest piercing the right lower pulmonary lobe and causing a haemothorax of 200 ml, an abdominal stab wound without involvement of a parenchymatous organ as well as multiple defence wounds of the arms. Thereafter, a second perpetrator was thought to have inflicted several heavy blows with a full water bottle causing severe contusions on the right side of the forehead, the chin, the left side of the face and a spider's web fracture of the frontal bone. Using the ISS an injury severity score of 24 was assigned to the first complex of injuries and a score of 10 to the second complex. The forensic conclusions with regard to prognosis and lethal outcome are discussed.     

Evaluation of atypical stab and incision wounds in a case of combined suicidal injuries

A fatal case of stabbing and cutting is reported which involved a 37-year-old male who suffered from depressive disorder and had already attempted suicide in the past. The postmortem examination revealed 12 lacerations of the scalp, 5 deep incised wounds on the flexor surface of the right forearm, 3 stab wounds of the back of the head, 12 stab wounds of the chest (with cutting of ribs but no injury of heart and lungs), 35 stab wounds of the abdomen and deep incised wounds of both sides of the neck with hesitation marks and incision of the left internal jugular vein. The significance of criteria to properly establish the manner of death like localization, axis and pattern of the wounds, hesitation marks, defense wounds, pulling aside the clothing to expose the target area, sustained capacity of physical activity and potential lethal effects of the single injuries as well as conclusions from the scene of death are discussed.     

Precision of estimating the time since death by vitreous potassium--comparison of two different equations

The precision of death time estimation by vitreous potassium using two different formulas [1-3] is compared on an independent random sample of 100 cases. The very flat slope in Sturner's equation is the reason for a systematic overestimation of the time since death with much wider 95%-limits of confidence compared to the results using an own equation with a steeper slope of vitreous potassium.     

Electrical excitability of skeletal muscle postmortem in casework

The paper gives a review of the development of methods of postmortem electrical excitability of skeletal muscle for determining the time since death. For practical application in casework, the following method can be proposed: position of electrodes in the orbicularis oculi muscle, stimulation by rectangular impulses of 10 ms duration, 30 mA in a repetition rate of 50/s. The muscular reaction on excitation is graded in 6 degrees according to the spread of movement and the intensity of contraction. To each degree a time information is corresponding (95%-limits of confidence). These 95%-limits of confidence were proved to be valid for cases of sudden natural or traumatic deaths. Exclusions: deaths after chronic lingering disease (shorter times), fatal hypothermia, haematomas, emphysemas of the eyelid (longer times). The practical application in casework together with the temperature method (Henssge 1988, 1) is described. Applying both methods the death time estimation in the early postmortem interval may be much more precise and accurate than using one method alone.     

Planned complex suicide by self-poisoning and a manipulated blank revolver: remarkable findings due to multiple gunshot wounds and self-made wooden projectiles

A remarkable case of complex suicide with poisoning and multiple self-inflicted gunshot wounds to the head is reported. After ingestion of a liquid insecticide, the victim shot himself twice in the head, once in each temple. Self-manufactured wooden dowels were used as projectiles in combination with conventional blank cartridges. The dowels had been glued on top of the blank cartridges and expelled by propellant gases. Moreover, the blank revolver used had been extensively manipulated in a rarely observed manner. Several occlusive devices had been removed from the barrel and the cylinder chamber to enable the expulsion of the wooden projectiles. The investigation of the methods used and the circumstances found at the scene pointed towards a planned complex suicide. A remarkable case with unusual projectiles, i.e., wooden dowels, fired by an extensively manipulated blank gun is reported, emphasizing the importance of close collaboration between the police firearm laboratory and forensic pathology in practical casework.     

Brain amino acid abnormalities in liver disease--a postmortem study

In a postmortem exploratory study, we examined whether specific amino acid abnormalities associated with liver diseases in vivo may also be detected in human brain samples obtained at clinical autopsies. The branched-chain amino acids (BCAA: valine, leucine, isoleucine) were decreased in the group of patients with liver diseases compared with the control group, whereas the aromatic amino acids (AAA: phenylalanine, tyrosine) were increased. However, the ranges overlapped significantly and were not statistically different. The molar ratio BCAA/AAA was determined to be 1.92 in the collection of patients with liver diseases compared with 2.27 in the control group. In patients with liver disease, ornithine concentrations in the brain appeared significantly decreased whereas glutamine was significantly increased. No significant difference was found in the brain concentrations of proline. Amino acid analysis may contribute to the understanding of pathophysiological mechanisms of liver disease, which are discussed, and may supplement the postmortem diagnosis.