Carbon monoxide poisoning from indoor barbecues--incidents reported to the German-speaking Poison Information Centers and the German Federal Institute for Risk Assessment (BfR) in Berlin

From 2008 to the end of 2009 the Joint Poison Information Center (PIC) in Erfurt observed 7 incidents involving 17 persons (1 fatality) with signs of carbon monoxide poisoning from indoor barbecues (COFIB). To find out whether COFIB is a regional or a general phenomenon in Germany, Austria and Switzerland, all information about COFIBs recorded by the 11 German-speaking Poison Information Centers and the BfR Berlin were retrospectively analyzed for the period 2000 to 2009. In all, 60 COFIBs (accidental: 90.0 %, suicidal: 8.3%, reason unknown: 1.7%) involving 146 individuals were reported. The number of incidents increased from one case with 2 persons in 2000 to 18 cases involving 34 persons in 2009. The 146 victims (female 26.7%, male 27.4%, gender unknown 45.9%; adults 58.2%, children 24.7%, age unknown 17.1%) lived in 15 of the 16 federal states of Germany and in Switzerland. The highest number of victims was found in Bavaria (23), Brandenburg (18), and Baden-Wuerttemberg (18). The symptoms according to the Poisoning Severity Score were none to mild in 60.3%, moderate in 13.7%, severe in 11.6%, fatal in 6.9% and unratable in 7.5%. No clear correlation was found between the carboxyhemoglobin concentration and the severity of the symptoms. As a rising number of COFIBs often involving several individuals was observed from 2000 to 2009, the general public was informed about the risks of indoor barbecues.     

Medical and legal aspects of genital mutilation and circumcision. Part II: Male circumcision

In the last few years, male circumcision has become the subject of controversial discussion. On the one hand, medical and hygienic arguments, ideology, freedom of religion, cultural identity and social adequacy are claimed by those supporting male circumcision. On the other hand, the justification of this practice also has to be critically scrutinized just as the question whether the parents have the right to consent to the operation. Today, opinions range from those who claim that religion and culture alone justify the practice to those who consider circumcision of minors unable to give their consent as bodily injury subject to punishment. In contrast to female genital mutilation, most positions do not postulate that circumcision violates morality. If the person concerned is able to give his consent, freedom of religion may also justify circumcision after weighing its pros and cons as well as its risks and potential side effects.     

Fatal Candida tropicalis infection in an 8-month-old infant with an aplasia of the thymus as a rare cause of death in infancy

Anomalies of the thymus can lead to immunodeficiencies that are often associated with complex syndromes. The clinical relevance of those anomalies varies a lot. Regarding mortality and morbidity, opportunistic infections play a major role in immunocompromised individuals. Case report: An 8-month-old infant died of a sepsis with multi-organ failure after 32 days in intensive care. At autopsy, no thymus gland could be found; toxicological examinations yielded high morphine concentrations. Autopsy findings and the results of further examinations performed postmortem are discussed in view of the clinical findings, the classification and the cause of death.     

Justizanwalt

Ohne Zusammenfassung     

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.     

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.     

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.     

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.     

Accidental death of disoriented persons in long term care facilities

Five cases of accidental death occurring in connection with physical restraints in long-term care facilities are reported. The position in which the deceased were found, autopsy findings, police investigations as well as the evaluation of each case under criminal law are described. The investigations by the prosecution as well as the attention of the public media have meanwhile contributed to an improvement of the technical standards and a reduction of the risk in applying such restraints under the Law on Medical Devices.