Mitral valve prolapse syndrome as cause of sudden death in young adults

Mitral valve prolapse syndrome (MVPS) is a relatively common disorder of the mitral valve and most cases take a benign clinical course. Only a subset of patients develop severe clinical symptoms such as arrhythmia, insufficiency of the mitral valve or infective endocarditis. As a consequence, sudden death might occur in these patients, thought to be caused by an arrhythmogenic event. By presenting six cases of sudden unexpected death in young female adults, we point at clinical and pathological data from the literature, which are of interest from the viewpoint of legal medicine. The incidence of MVPS in autopsy series has been reported to be about 4-5%, while clinical data hint at an incidence of about 2.5%. The presented cases suggest that even clinically benign cases of MVPS in young adults might result in sudden unexpected death. Such cases are not included in hospital based studies on the topic. This might lead to an underestimation of the fatal risk associated with the disease, even if sudden death might be a rare event in MVPS.     

Self-made "electric chair" for sexually motivated child abuse of children

A 52-year-old man had altered a wooden folding chair by placing two electrodes and a circuit underneath the seat. Using a remote control, he was able to give electric shocks to a person sitting on the chair. He used this device on more than 50 children, video-taping their reactions for his own pleasure. There are no reports that any of the children suffered a lasting damage to their health. The construction as well as the function and the electrical parameters of the chair were examined by forensic specialists. According to their expertise, the construction was not able to cause a potentially life-threatening condition when used with healthy children. The perpetrator was convicted for bodily harm etc.     

Homicide-suicide in the change of time

Homicide-suicide is a rare event compared to suicide and homicide alone. A comparison of the statistical figures of two studies for Hamburg (1950-1961 and 1990-2005) shows a significant development within the last 40 years: the total number of homicide-suicides committed by women has decreased considerably, probably due to a better medical and psychiatric care and greater economic independence, whereas the number of male perpetrators has remained constant. However, these perpetrators are younger now. As far as the methods are concerned, shooting is now the most common means of killing instead of poisoning by coal gas in former days.     

A forensic medicine perspective on recurring episodes of intimate partner violence

During a three year period, 418 victims of intimate partner violence (IPV) were examined and their injuries documented at the Center for Victims of Violence (CVV) in Hamburg, Germany. All victims were questioned if their acute injuries were attributable to recurring acts of violence by the same intimate partner. The victims' experiences with recurring IPV were analyzed and associated risk factors as well as findings of acute physical injuries were integrated into the assesment. Overall, women were significantly more often victims of recurring episodes of IPV than men. In 35.4% of cases, victims of recurring IPV sustained injuries to three or more body regions. However, women who were victimized during a single act of violence, presented with the same distribution of injuries in only 21.1% of cases (p = 0.01). The results emphasize the fact that IPV often manifests itself in a spiraling escalation of physical violence. Furthermore, blunt force trauma to the head was diagnosed significantly more often (p = 0.05). The risk of sustaining a head injury was equally high for women who experienced a first-time violent episode by their ex-partner as it was for married women or women living in a non-marital partnership during recurring episodes of IPV. In an effort to reduce the increased risk for victims of IPV, health care personnel are highly encouraged to partake in forensic medicine based continuing education. This preventative measure may prepare clinicians to recognize IPV earlier as well as to treat and advise clients appropriately.     

Computed tomography as routine in connection with medico-legal autopsies

CT-scanning as routine examination before medico-legal autopsy was introduced at the Institute of Forensic Medicine in Copenhagen, Denmark, in December 2002. The present series comprises of 525 medico-legal examinations performed in the year 2003. The purpose is to determine the value of CT-scanning prior to the post-mortem examination. All findings, CT- as well as patho-anatomic findings - more than 4000 - were registered in a database. To increase the clearness, the findings are divided in accordance to regions such as head, thorax, abdomen, pelvis, extremities and vessels and the CT-findings are compared to the patho-anatomic findings, with the purpose to estimate the advantages and disadvantages with the two types of examination. The preliminary results show, that the CT-scanner is superior when it comes to detection of extremity fractures. The scanner has ability in detecting hemorrhages and hematomas, especially, intracranial.     

Predictors of re-offending in German substance-abusers in legal detention: a prospective population-based cohort study

This study aimed to evaluate whether the elapsed time after release to first re-offense is longer for those who complete coerced forensic addiction treatment than for those who fail to complete the treatment. It is also aimed to identify predictors of re-offending for both those who complete such treatments as compared with those who do not. Two hundred and sixty-one patients discharged from five German forensic addiction clinics were investigated on 65 anamnestic, socio-demographic, and therapeutic process variables. One hundred and fifty-one patients were prematurely discharged and returned to prison (group A; time at risk [TAR] = 58.7 months), 110 finished treatment successfully (group B; TAR = 44.2 months). Federal Criminal Register data were used for follow-up. Univariate survival analyses and multivariate stepwise Cox-regression models were computed. Twelve predictors in group A revealed a four-factor model: age at admission to treatment, duration of concurrent prison sentence, number of entries in the criminal register, and attendance at prior substitution programs. The model for group B covered five out of eight predictors: regular working activities before first diagnosis of mental illness, type of main offense, (secondary) traffic offenses, outpatient rehabilitation treatments, and escapes during treatment. Successful completers of forensic addiction treatment are slower to re-offend than non-completers.