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.     

Pneumatic spaces of the zygomatic arch (zygomatic air cell defect) on pantomograms--an aid for age determination and identification

The analysis of panoramic radiographs of the jaws for forensic purposes is well established. The dental findings on the radiographs give valuable information concerning the identity and possible age. Panoramic radiographs also depict the zygomatic arches. Pneumatized spaces of the temporal bone's zygomatic arch process are asymptomatic variations, entitled "zygomatic air cell defect" (ZACD). Data on ZACD prevalence might support the current forensic-odontologic practice in the fields of identification and age assessment. The authors analyzed 6 studies subjected to evaluate ZACD on panoramic radiographs. The out-patients were subjected to systematic radiography prior to treatment planning in specialized dental or maxillofacial surgery clinics. The age of the 7870 patients varied between 6 and 97 years. ZACD was found in 169 patients (prevalence: 2.32%; female: 56.12%, male: 43.9%). Most ZACD were unilateral (70%). In these studies no ZACD occurred in children younger than 7 years of age. There was no statistically significant difference concerning ZACD prevalence in the sub-groups of children aged 9 to 13 vs. 14 to 17 years. This review demonstrates the prevalence of ZACD on orthopantomograms. The prevalence of this finding in the investigated children does not differ from the prevalences reported for adults, and is low in general. The presence of ZACD in persons might be valuable for the identification of humans or human remains and for age estimation in addition to other physical and dental findings.     

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.     

Mandibular fracture following stab injury with a knife

Stab injuries of the face accompanied by fractures of the jaws are rare. The report deals with the case of a young man, who suffered a penetrating stab injury to the cheek and fracture of the mandible in an assault. The forensic questions to be answered were if the findings were compatible with a stab and subsequent fracture, if one of the confiscated instruments could have been the causative weapon and if the injury had to be assessed as life-threatening. Both the soft and the hard tissue injury confirmed the assumption that they were caused by a stab. It was not possible, however, to assign the injury to a specific knife from the submitted exhibits on the basis of the clinical findings. In the discussion the serious nature of stab injuries in the facial region is emphasized.     

Health care reform in Germany: patchwork change within established governance structures

Under the pressure of health care reform in the 1990s, interactions among the state, sickness funds, and providers in Germany are said to have entered a new era. We examine this new era by assessing both long-term developments connected to German statutory health insurance (SHI) and related short-term developments of the 1990s. Highly institutionalized rules and practices provide little opportunity for abandoning the historical path of two primary factors: the self-governance of SHI and a strong tradition of a semisovereign state. Some opportunities exist for introducing new ideas, rearranging priorities, softening rules, and adding new complex rules and procedures in a fairly fragmented policy-making system, perhaps even because of fragmentation. Yet reforms that depart from the status quo are severely limited by strong legal and administrative traditions and established rules of the game. These restrictions tend to reinforce state intervention, prevent the emergence of consistent and coherent visions of future health policy, and stifle policy innovation and implementation. In sum, reform measures tend to remain well within the priorities established within state and corporatist governance structures.     

Analysis of potassium permanganate as addictive drug "precursor"

Potassium permanganate is used for the production of cocaine and methylcathinone. The third convention of the UN against narcotic drugs (1988) contains a list of so-called precursors, substances commonly used for the production of narcotic drugs. The control of the precursors can be a very important step to prevent the illicit production of narcotic substances. A chemical characterization of a seized product may contribute to determine the origin of the producing company and the trade channels and to prevent further illicit deliveries. 31 samples of permanganate (19 authentic and 12 seized samples) have been analyzed for 9 metallic elements. Detailed procedures for the emission spectrography and ICP-analysis are given and the range of concentrations is tabulated. It was surprising that no significant concentrations of metals like chromium, nickel or cobalt were present. Nor was the difference between the technical and analytically pure products sufficient to make a differentiation according to origin. This is probably attributable to the technical manufacture of permanganate by electrolysis. All the statistical analyses of the results performed on the available data do not allow conclusions as to the country of origin or manufacturer, as production batches of one and the same manufacturer may also show differences. Only the morphology of the product (crystals, powder or "free flowing") allows a certain characterization. Nevertheless it seems necessary to analyze all seized samples for impurities and to establish a table of "impurity profiling" in the future in order to receive more information and to find correlations in selected cases.     

Fatal parvovirus B19 myocarditis in an 8-year-old boy

A report is given on an 8-year-old boy who suddenly and unexpected died. Autopsy findings point to acute heart failure. Microscopic examination of the heart showed increased interstitial and perivasal fibrosis and myocarditis with macrophage infiltration. Polymerase chain reaction (PCR) analysis for parvovirus B19 was positive in heart samples and in the spleen. Immunostaining for parvoviral surface antigens was negative. Although the virus does not appear to have infected the cardiomyocytes, we speculate that myocarditis arose from immunological cross-reaction to epitopes shared between the virus and the myocardium.     

What differentiates anal rapists from vaginal rapists?

During the daily assessment routine of the Federal Documentation Centre for Sexual Offenders, important differences between rapists who commit their offense through anal penetration and other rapists became apparent. The hypothesis following these findings assumed that these and offenders would show a more sexualized behaviour than other rapists. The following differences between these two groups could be shown: violence and hypersexual desire. And rapists show a significantly higher degree in both areas, whereas, on the other side, no difference concerning psychopathic behaviour of the offenders could be proved. The preliminary conclusions that could be drawn according to these results express that anal rapists are more sexualized and, furthermore, they have a more obsessive sex life.     

Cleaning Puparia for Forensic Analysis

We tested procedures for removing adipocere from insect samples to allow identification. An acceptable procedure was determined: (i) Samples were sorted in petri dishes with 75% alcohol to remove any larvae, adult insects, or other soft‐bodied material. (ii) Samples of up to 24 puparia were placed in a vial with 15 mL of 95% acetone, capped, and vortexed for a total of 30–90 sec in 10‐ to 15‐sec bursts. This step removed large masses of adipocere or soil from specimen. (iii) Specimens were removed from acetone and placed in a vial of 15 mL of 2% potassium hydroxide (KOH) and vortexed in 10‐ to 15‐sec bursts until all puparia appeared clean (with our samples this required a total of 60–120 sec). (iv) Specimens were removed from the 2% KOH, placed in 75% ethanol, and examined microscopically. (v) Material was stored in 75% ethanol for identification and long‐term preservation.     

Palynological Investigation of Mummified Human Remains

Pollen analysis was applied to a mummified homicide victim in Nebraska, U.S.A., to determine the location of death. A control sample showed the normal ambient pollen in the garage crime scene. Ambient windborne types, common in the air of the region, dominated the control. Internal samples were analyzed from the sacrum, intestine, and diaphragm. Microfossils were recovered from the rehydrated intestine lumen. The intestinal sample was dominated by Brassica (broccoli). The sacrum sample was high in dietary types but with a showing of ambient types. The pollen from the diaphragm was dominated by ambient pollen similar to the control samples. The discovery of diverse pollen spectra from within a single mummy was unexpected. They show that ingested and inhaled pollen mixed in the corpse. The data linked the decedent to a specific crime scene in her Nebraska home in the southern tier of eastern counties on the border with Kansas.