Case histories in forensic medicine

Case histories make up a great part of publications in forensic medicine, especially forensic pathology, although considered low on the hierarchy of evidence based medicine because of its inherent anecdotal nature. Meanwhile some journals exclude case histories categorically from publication. The boom of case histories in forensic medicine has not only opportunity reasons (easily [even mental] and cheap to do) but also structural reasons: due to its tasks in case work many items of forensic medicine can not be simulated experimentally for ethical reasons (violent death, traumatic injuries, sexual assault, poisonings, influence of alcohol and drugs on driving ability and legal responsibility, medical malpractice, adverse events during medical care). In these fields the role of case histories is mainly the augmentation of experience based knowledge. However, quality aspects have to be considered and case histories should be the basis for systematic or hypothesis based research.     

Death time estimation in case work. II. Integration of different methods

The mean value of the time of death is not reliable because of the great variability of the time-dependent criteria of dead bodies. However, it is possible to narrow down a reliable time period for a stated death by means of the lower and upper limits of error of different criteria. The external data of lividity, rigor, mechanical and electrical excitability of facial muscles and the chemical excitability of the iris have all been gathered from literature, chronologically arranged and clearly presented. After rectal temperature measurement and a corresponding nomogram reading, it is simple to choose other suitable criteria and to integrate them with the aid of a chart thus producing a rational and practical procedure for use at a scene of crime.     

Cytomegalovirus-induced pneumonia and myocarditis in three cases of suspected sudden infant death syndrome (SIDS): diagnosis by immunohistochemical techniques and molecularpathologic methods

Immunohistochemical and molecularpathologic techniques have improved the diagnosis of myocarditis as compared with conventional histologic staining methods done according to the Dallas criteria. Additionally, immunohistochemistry and in situ-hybridization are able to demonstrate viral infection, e.g. cytomegaloviruses in salivary glands and lungs, locations both known to be involved in cytomegalovirusinfection. However, in many cases of proved cytomegalovirusinfection the cause of death remains unclear. We report on three children younger than 1-year of age, who died suddenly without prodromal symptoms. Their deaths were attributed to SIDS (sudden infant death syndrome). In situ-hybridization, immunohistochemical (LCA, CD45R0, CD68, MHC-class-II-molecules, E-selectine) and molecularpathologic investigations (PCR), however, suggested that death was caused by a cytomegalovirus-induced pneumonia or myocarditis. In the future, these methods should be used for investigating cases with suspicion of SIDS.     

Postmortem increase in potassium in the vitreous humor. Which parameters are suitable as indicators of antemortem agonal electrolyte imbalance?

The relationship between a rise in the potassium concentration in the vitreous humor and the time of death has been established by several authors. Sturner (1963) and Adelson (1963) have been able to demonstrate a more precise relationship between potassium and the time of death in cases of sudden death and death occurring within 6 h as opposed to death after a chronic, lingering disease. However, the duration of the terminal episode cannot always be assessed in forensic medicine. Therefore, it would be valuable if other parameters could also be established that would indicate an agonal dysregulation of electrolytes. Our study revealed that sodium, urea, chloride, and calcium are of great value in indicating antemortem electrolyte imbalance because of their stability in the vitreous humor after death. The first results established that urea may be a suitable internal standard.     

Child neglect death of an infant by faulty nutrition]

A 3 month old child was treated in hospital for "toxikosis and prolonged gastroenteritis". The child required a special diet. The parents picked up the child in hospital and brought it home against the device of the doctors. 26 hours later the child had died of severe exsikkosis (loss of 17% of body weight within one day). Using immunological methods (Ouchterlony test) we were able to demonstrate the child was fed with contraindicated food although the doctors had pointed out that the child needs a special diet. The parents were sentenced at court in two instances for manslaughter.