1
|
Holz F, Schlang C, Beig I, Dichter V, Hauschild N, Kersten S, Kettner M, Chabiera PJ, Birngruber CG, Verhoff MA, Koelzer SC. Correspondence regarding "Suicide trends in Germany during the COVID-19 pandemic and the war in Ukraine" by D. Radeloff et al. Psychiatry Res 2024; 333:115732. [PMID: 38232569 DOI: 10.1016/j.psychres.2024.115732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Affiliation(s)
- F Holz
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Frankfurt am Main, Germany.
| | - C Schlang
- Health Department Frankfurt am Main, Germany
| | - I Beig
- Health Department Frankfurt am Main, Germany
| | - V Dichter
- Health Department Frankfurt am Main, Germany
| | - N Hauschild
- Health Department Frankfurt am Main, Germany
| | - S Kersten
- Police Department, Criminal Investigation Department, Fatality Bureau, Frankfurt am Main, Germany
| | - M Kettner
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - P J Chabiera
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - C G Birngruber
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - M A Verhoff
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - S C Koelzer
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Frankfurt am Main, Germany
| |
Collapse
|
2
|
Wolf PM, Dettmeyer R, Holz F, Birngruber CG. Complex suicides involving the use of firearms and hanging: A retrospective study and review of the literature. Leg Med (Tokyo) 2023; 69:102337. [PMID: 37926655 DOI: 10.1016/j.legalmed.2023.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/03/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Suicides are the second most common cause of non-natural death in Germany after accidents. Most common is death by hanging, followed by the use of firearms. More frequent "simple" suicides in which one suicide method is used are distinguished from rare "complex" suicides, in which several methods are applied, whereby the combination of gunshot and strangulation is frequently chosen. Such cases require a thorough criminalistic and forensic medical examination to check the plausibility of assumed sequences of events and to detect covered-up homicides. MATERIAL AND METHODS A retrospective analysis of 5,400 post-mortem examinations at the Institute of Legal Medicine Giessen (2009-2018) revealed three cases in which gunshot and hanging were used to commit a planned complex suicide. RESULTS Case 1: The body of a 66-year-old carcinoma patient was found hanging from a tree in a kneeling position with a bullet through the head. The post-mortem examination revealed a penetrating head shot, uninjured soft tissues of the neck, no injuries to the hyoid bone or larynx and no signs of congestion. After autopsy, the gunshot through the head was considered as cause of death. Case 2: An 82-year-old man was found dead with two bullet wounds in the chest, hanging in free suspension in a factory hall. The necropsy showed two chest entry wounds with injuries to the heart and lungs as well as a vital ligature mark and fractures of the hyoid bone and larynx without signs of congestion. The combination of hanging and the gunshot wounds was concluded as cause of death. Case 3: The body of an 81-year-old pain patient was found in his home next to a small-caliber rifle, with a noose around his neck, attached to a suspension torn from the wall. The autopsy revealed a tangential shot through the skull with superficial injury to the frontal brain and a vital cord mark on the neck with fractures of the hyoid bone and larynx without signs of strangulation. In this case, hanging was identified as cause of death. CONCLUSION Complex suicides are rare events, that require a thorough criminalistic and forensic medical examination Although being called complex suicides and one of the methods usually being suitable to cause death, the cause of death is not always a combined one.
Collapse
Affiliation(s)
- P M Wolf
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Kennedyallee 104, 60596 Frankfurt am Main, Germany
| | - R Dettmeyer
- Institute of Legal Medicine, University Hospital Giessen and Marburg, Justus Liebig University, Frankfurter Str. 58, 35392 Giessen, Germany
| | - F Holz
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Kennedyallee 104, 60596 Frankfurt am Main, Germany
| | - C G Birngruber
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe University, Kennedyallee 104, 60596 Frankfurt am Main, Germany.
| |
Collapse
|
3
|
Ohlwärther TEN, Holz F, Edler K, Kölzer SC, Reuss E, Verhoff MA, Birngruber CG. Bone finds and their medicolegal examination: a study from Hesse, Germany. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00599-1. [PMID: 37067670 DOI: 10.1007/s12024-023-00599-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 04/18/2023]
Abstract
Bones found by chance can be of great criminal or historical interest. The nature of their appraisal depends on the individual case, the locally effective legislation and the available resources. To assess whether a find is relevant with respect to criminal investigation, the circumstances of the find and the results of the forensic examination carried out by trained personnel must be considered. The aim of this study was to obtain an overview of the circumstances and nature of the finds as well as the results of the subsequent expert opinions by evaluating bone finds from the federal state of Hesse, Germany. For this purpose, over a 10-year period from 2011 to 2020, all bone finds examined at the Institutes of Legal Medicine in Gießen and Frankfurt am Main, Germany, were evaluated retrospectively with regard to the locations and circumstances of the finds, their nature (human or non-human), the postmortem interval, possible traces of violent impact and the results of further examinations. Of the 288 bone finds evaluated, 38.2% were found in forests, meadows and parks. In 50.7%, the finds contained human bones, of which 37.0% had a forensically relevant postmortem interval of 50 years or less. Evidence of trauma was described in 77.4% of the human bone cases: postmortem damage in 78.8%, peri-mortem injury in 9.7% and ante-mortem injury in 11.5%. DNA examinations were performed in 40.4% of the human bone finds. They yielded STR profiles in 81.3%, leading to a definite identification in 35.4%. Among the non-human bones sent in, the most common were bones from pigs (23.4%), deer (18.1%), cattle (16.4%), roe deer (11.7%) and sheep (11.7%). The macroscopic examination is the first step of the forensic-osteological evaluation and sets the course for further examinations or investigations. DNA examinations are of great importance for the reliable identification of human bones. They were responsible for 70.8% of successful identifications.
Collapse
Affiliation(s)
- T E N Ohlwärther
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, Frankfurt am Main, 60596, Germany
| | - F Holz
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, Frankfurt am Main, 60596, Germany
| | - K Edler
- Institute of Legal Medicine, University Hospital Gießen and Marburg, Justus-Liebig-University, Gießen, Germany
| | - S C Kölzer
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, Frankfurt am Main, 60596, Germany
| | - E Reuss
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, Frankfurt am Main, 60596, Germany
| | - M A Verhoff
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, Frankfurt am Main, 60596, Germany
| | - C G Birngruber
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Kennedyallee 104, Frankfurt am Main, 60596, Germany.
| |
Collapse
|
4
|
Haberer B, Dettmeyer R, Birngruber CG. Rechtsmedizinische Leichenfundortuntersuchung mit Leichenschau. Rechtsmedizin (Berl) 2023. [DOI: 10.1007/s00194-022-00608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Zusammenfassung
Hintergrund
Die Leichenfundortuntersuchung mit rechtsmedizinischer Leichenschau im Vorfeld der Obduktion kann für deren Planung hilfreich sein. Häufigkeit, Umfang und Art der dokumentierten Leichenfundortuntersuchung mit Leichenschau unterliegen interindividuellen und interinstitutionellen Einflüssen. Eine wissenschaftliche Untersuchung rechtsmedizinischer Leichenfundortuntersuchungen und eine systematische Standardisierung gibt es bisher nicht.
Material und Methoden
Insgesamt 3622 Akten aus dem Archiv des Instituts für Rechtsmedizin der Justus-Liebig-Universität Gießen aus den Jahren 2005–2014 wurden gesichtet. 121 Fälle mit einer Leichenfundortuntersuchung mit Leichenschau durch eine/n Rechtsmediziner/in vor Ort wurden ausgewertet.
Ergebnisse
Die Leichenfundortuntersuchungen, einschließlich Dokumentation der Befunde, wurden während des 10-jährigen Untersuchungszeitraums unterschiedlich gehandhabt. Es zeigte sich eine Zunahme an Leichenfundortuntersuchungen um rund 380 % vom ersten zum letzten Untersuchungsjahr. Der Anteil an Tötungsdelikten bei den Leichenfundortuntersuchungen betrug 46 %. In 63 % aller Fälle fanden sich Dokumentationslücken, die im Verlauf des Untersuchungszeitraums und mit der häufigeren Anfertigung von Leichenfundortuntersuchungsberichten deutlich abnahmen. Bei der Dokumentation von Verletzungsmustern sank der Anteil an unvollständigen Daten von 89 % auf 11 %, bei den Temperaturmessungen am Leichenfundort von 73 % auf 27 %. Exklusiv am Leichenfundort erhebbare dokumentierte Zusatzinformationen fanden sich im Sinne von Blutspurenverteilungsmustern (48 %) und Hinweisen auf mögliche Tatwerkzeuge (57 %).
Schlussfolgerungen
Die rechtsmedizinische Leichenfundortuntersuchung mit Leichenschau wurde zunehmend häufiger durchgeführt. Die Untersuchung des Leichnams vor Ort und die Inaugenscheinnahme der Umgebung liefern Informationen, die über die alleinige autoptische Befunderhebung hinausgehen und eine wertvolle Grundlage für die Einordung von Obduktionsbefunden und für rekonstruktive Überlegungen zu Tatgeschehen darstellen. Um die Qualität der Befunderhebungen am Leichenfundort und die Qualität der zugehörigen Dokumentation zu verbessern, ist eine standardisierte Leichenfundortuntersuchung mit Leichenschau und Dokumentation anzustreben.
Collapse
|
5
|
Holz F, Verhoff MA, Mückenberger K, Kántor F, Schulte JE, Krause V, Kozlowski J, Birngruber CG, Wunder C, Zehner R, Fischer S, Betz W, Kölzer SC. Euthanasie im Nationalsozialismus – Untersuchungen an drei Skeletten der Kriegsgräberstätte Idstein-Kalmenhof (Hessen). Rechtsmedizin (Berl) 2023. [DOI: 10.1007/s00194-022-00612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Zusammenfassung
Hintergrund
Der Kalmenhof wurde 1888 vom „Verein für die Idiotenanstalt zu Idstein“ gegründet. Während der NS-Zeit wurden in der „Kinderfachabteilung“ hunderte Kinder und Jugendliche von Ärzten und Pflegern getötet.
Material und Methoden
Nachdem ein historisches Gutachten und Georadaruntersuchungen Hinweise auf Gräber außerhalb einer als Kriegsgräberstätte ausgewiesenen Fläche erbrachte, erfolgten im Sommer 2020 Grabungen.
Ergebnisse
Außerhalb der Kriegsgräberstätte fanden sich keine Gräber. Innerhalb des Areals wurde eine Mehrfachbestattung von drei Individuen in einer 160 × 65 cm großen Grube entdeckt. Die knöchernen Überreste wurden exhumiert und makroskopisch, radiologisch, toxikologisch und molekulargenetisch untersucht. Zwei Individuen waren männlich, das Sterbealter betrug etwa 2,0 bis 2,25 Jahre und 2,5 Jahre. Das dritte Individuum war eine Jugendliche, die Untersuchungen ihrer sterblichen Überreste erbrachten Hinweise auf wiederholte und längere Zeit bestehende Phasen mit unzureichender Nährstoffversorgung. An keinem der Individuen fanden sich Zeichen einer körperlichen Behinderung, prä- oder perimortale Verletzungen. Die toxikologischen Untersuchungen verliefen für alle Individuen negativ. Für die beiden kindlichen Skelette konnte ein vollständiges STR-Profil erstellt werden, an dem jugendlichen Skelett gelang lediglich eine Geschlechtsbestimmung.
Diskussion
Die Ergebnisse stützen historische Angaben, wonach Gräber mehrfach belegt wurden. Demgegenüber war eine Unterteilung des Friedhofes nach dem Sterbealter nicht nachvollziehbar, ebenso wenig, dass sich auf angrenzenden Grundstücken Gräber befinden. Durch die gewonnenen Erkenntnisse wurde ein konkreter Identitätsverdacht für die drei Individuen erarbeitet. Die knöchernen Überreste wurden am Volkstrauertag 2020 im Rahmen einer Gedenkveranstaltung wieder beigesetzt.
Collapse
|
6
|
Heide S, Birngruber CG. Todesfälle in staatlichem Gewahrsam und psychiatrischen Einrichtungen. Rechtsmedizin (Berl) 2022. [DOI: 10.1007/s00194-022-00570-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
7
|
Birngruber CG, Ohlwärther TEN, Weyrich A, Dettmeyer RB. Tod nach Einsatz eines Distanzelektroimpulsgerätes (TASER X2). Rechtsmedizin (Berl) 2022. [DOI: 10.1007/s00194-022-00569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
von Stillfried S, Freeborn B, Windeck S, Boor P, Böcker J, Schmidt J, Tholen P, Röhrig R, Majeed R, Wienströer J, Bremer J, Weis J, Knüchel R, Breitbach A, Bülow RD, Cacchi C, Wucherpfennig S, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Spring O, Braun G, Römmele C, Kling E, Kröncke T, Wittmann M, Hirschbühl K, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Friemann J, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Esposito I, Crudele G, Seidl M, Mahlke N, Hartmann A, Haller F, Eichhorn P, Lange F, Amann KU, Coras R, Ingenwerth M, Rawitzer J, Schmid KW, Theegarten D, Gradhand E, Smith K, Wild P, Birngruber CG, Schilling O, Werner M, Acker T, Gattenlöhner S, Franz J, Metz I, Stadelmann C, Stork L, Thomas C, Zechel S, Ströbel P, Fathke C, Harder A, Wickenhauser C, Glatzel M, Matschke J, Krasemann S, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Ondruschka B, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Jonigk D, Werlein C, Domke LM, Hartmann L, Klein I, Schirmacher P, Schwab C, Röcken C, Langer D, Roth W, Strobl S, Rudelius M, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weichert W, Weirich G, Stock K, Barth P, Schnepper A, Wardelmann E, Evert K, Evert M, Büttner A, Manhart J, Nigbur S, Bösmüller H, Fend F, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Vogt N, Kurz F. [Update on collaborative autopsy-based research in German pathology, neuropathology, and forensic medicine]. Pathologie (Heidelb) 2022; 43:101-105. [PMID: 36114379 PMCID: PMC9483541 DOI: 10.1007/s00292-022-01117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Autopsies are a valuable tool for understanding disease, including COVID-19. MATERIALS AND METHODS The German Registry of COVID-19 Autopsies (DeRegCOVID), established in April 2020, serves as the electronic backbone of the National Autopsy Network (NATON), launched in early 2022 following DEFEAT PANDEMIcs. RESULTS The NATON consortium's interconnected, collaborative autopsy research is enabled by an unprecedented collaboration of 138 individuals at more than 35 German university and non-university autopsy centers through which pathology, neuropathology, and forensic medicine autopsy data including data on biomaterials are collected in DeRegCOVID and tissue-based research and methods development are conducted. More than 145 publications have now emerged from participating autopsy centers, highlighting various basic science and clinical aspects of COVID-19, such as thromboembolic events, organ tropism, SARS-CoV‑2 detection methods, and infectivity of SARS-CoV-2 at autopsy. CONCLUSIONS Participating centers have demonstrated the high value of autopsy and autopsy-derived data and biomaterials to modern medicine. The planned long-term continuation and further development of the registry and network, as well as the open and participatory design, will allow the involvement of all interested partners.
Collapse
Affiliation(s)
- Saskia von Stillfried
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Benita Freeborn
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Svenja Windeck
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | - Peter Boor
- Institut für Pathologie, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Medizinische Klinik II (Nephrologie und Immunologie), Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland ,Elektronenmikroskopische Einrichtung, Universitätsklinik RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Deutschland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Plenzig S, Holz F, Bojkova D, Kettner M, Cinatl J, Verhoff MA, Birngruber CG, Ciesek S, Rabenau HF. Detection and infectivity of SARS-CoV-2 in exhumated corpses. Int J Legal Med 2021; 135:2531-2536. [PMID: 34302215 PMCID: PMC8302458 DOI: 10.1007/s00414-021-02670-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
Postmortem detection of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) after the exhumation of a corpse can become important, e.g. in the case of subsequent medical malpractice allegations. To date, data on possible detection periods [e.g. by reverse transcription polymerase chain reaction (RT-PCR)] or on the potential infectivity of the virus after an exhumation are rare. In the present study, these parameters were examined in two cases with a time span of approximately 4 months between day of death and exhumation. Using SARS-CoV-2 RT-PCR on swabs of both lungs and the oropharynx detection was possible with cycle threshold (Ct) values of about 30 despite signs of beginning decay. RT-PCR testing of perioral and perinasal swabs and swabs collected from the inside of the body bag, taken to estimate the risk of infection of those involved in the exhumation, was negative. Cell culture-based infectivity testing was negative for both, lung and oropharyngeal swabs. In one case, RT-PCR testing at the day of death of an oropharyngeal swab showed almost identical Ct values as postmortem testing of an oropharyngeal swab, impressively demonstrating the stability of viral RNA in the intact corpse. However, favorable climatic conditions in the grave have to be taken into account, as it was wintertime with constant low temperatures. Nevertheless, it was possible to demonstrate successful postmortem detection of SARS-CoV-2 infection following exhumation even after months in an earth grave.
Collapse
Affiliation(s)
- S Plenzig
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Germany.
| | - F Holz
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| | - D Bojkova
- Institute of Medical Virology, Goethe University, University Hospital Frankfurt, Paul-Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany
| | - M Kettner
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| | - J Cinatl
- Institute of Medical Virology, Goethe University, University Hospital Frankfurt, Paul-Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany
| | - M A Verhoff
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| | - C G Birngruber
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| | - S Ciesek
- Institute of Medical Virology, Goethe University, University Hospital Frankfurt, Paul-Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany.,German Centre for Infection Research, External Partner Site, 60323, Frankfurt am Main, Germany.,Branch Translational Medicine and Pharmacology, Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), 60596, Frankfurt am Main, Germany
| | - H F Rabenau
- Institute of Medical Virology, Goethe University, University Hospital Frankfurt, Paul-Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany
| |
Collapse
|
10
|
Plenzig S, Holz F, Kettner M, Verhoff MA, Birngruber CG. Das Projekt rechtsmedizinische Leichenschau in Frankfurt am Main – Erste Leichenschau vs. Sektionsergebnisse. Rechtsmedizin (Berl) 2021. [DOI: 10.1007/s00194-021-00480-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Hintergrund
In Frankfurt am Main (~750.000 Einwohner) wird die erste Leichenschau im Auftrag der Polizei tagsüber durch einen dafür eingerichteten rechtsmedizinischen Dienst vorgenommen. Nachts und am Wochenende führen diese Tätigkeit Ärzte des ärztlichen Bereitschaftsdienstes (ÄBD) der kassenärztlichen Vereinigung durch.
Material und Methoden
Für das Jahr 2019 wurden die im Rahmen dieser ersten Leichenschauen ausgestellten Leichenschauscheine hinsichtlich der attestierten Todesart ausgewertet und die Ergebnisse mit denen einer ggf. im Nachgang durchgeführten Sektion, inklusive Zusatzuntersuchungen, verglichen. Von den Ärzten des ÄBD konnten 461 Leichenschauen in die Auswertung eingeschlossen werden, davon erfolgte in 76 Fällen eine Obduktion. Im Nachgang der 364 rechtsmedizinischen Leichenschauen wurden 78 Obduktionen durchgeführt.
Ergebnisse
Veränderungen in der Todesart nach Sektion ergaben sich für die Leichenschauen des ÄBD in 57, bei den rechtsmedizinischen Leichenschauen in 49 Fällen, wobei insbesondere eine bei Leichenschau attestierte ungeklärte Todesart in einen natürlichen Tod spezifiziert werden konnte. Nach der Obduktion fanden sich bei den rechtsmedizinischen Leichenschauen 8 Fälle, bei denen des ÄBD 19 Fälle eines nichtnatürlichen (statt weiterhin ungeklärten) Todes. Bei den rechtsmedizinisch beschauten Fällen änderte sich zudem nach der Sektion in einem Fall die Todesart von natürlich zu nichtnatürlich, bei denen des ÄBD kam es in einem Fall zu einer Änderung von nichtnatürlich zu natürlich.
Diskussion
Die Veränderung bzw. Spezifizierung der Todesart nach der Sektion beider Kollektive verdeutlicht, wie wichtig eine Steigerung der Sektionsrate wäre, und dass auch bei professioneller Durchführung der Leichenschau das Erkennen der Todesart Probleme bereitet.
Collapse
|
11
|
Abstract
ZusammenfassungMyokarditiden stellen nach der hypertrophen Kardiomyopathie und der stenosierenden Koronararteriensklerose die dritthäufigste Ursache des plötzlichen Herztodes dar. Die Klinik der Myokarditis ist wie ihr Verlauf äußerst variabel, und ihr Therapieerfolg hängt stark von der Ätiologie und somit einer umfassenden diagnostischen Abklärung ab. Zum Goldstandard gehört nach wie vor die Endomyokardbiopsie, deren Ergebnisse bedeutenden Einfluss auf die Therapieplanung haben können. Vorgestellt wird der Fall einer 35 Jahre alt gewordenen Frau, bei der zu Lebzeiten eine chronisch aktive lymphozytäre Myokarditis mit Nachweis des humanen Herpesvirus 6 (HHV 6) diagnostiziert wurde. Acht Monate nach der Diagnose verstarb sie unerwartet. Die Obduktion mit nachfolgender histopathologischer Aufarbeitung der Myokardproben erbrachte den Nachweis einer Riesenzellmyokarditis, die als Differenzialdiagnose zu Lebzeiten nicht gestellt worden war. Der Fall verdeutlicht die Problematik der Diagnosestellung zu Lebzeiten, wenn Myokardproben nicht repräsentativ sind zum Nachweis der Grunderkrankung und illustriert die autoptischen Befunde dieser seltenen Form der Myokarditis.
Collapse
|
12
|
Holz F, Saulich MF, Schröder AS, Birngruber CG, Verhoff MA, Plenzig S. Death abroad: Medico-legal autopsy results of repatriated corpses: A retrospective analysis of cases at the Department of Legal Medicine in Frankfurt am Main. Forensic Sci Int 2020; 310:110257. [PMID: 32224431 DOI: 10.1016/j.forsciint.2020.110257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/01/2020] [Accepted: 03/12/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Repatriated corpses may have been autopsied abroad. The aim of the study was to compare the findings from second medico-legal autopsies with those from primary autopsies abroad to spotlight possible implications for the management of repatriated corpses. MATERIAL AND METHODS All autopsies from a 20-year period at the Institute of Legal Medicine in Frankfurt am Main on repatriated corpses of German citizens were reviewed. The results were compared with the information from the body passports, the protocols of the autopsies in the country of death, and the police files. RESULTS In total, 151 corpses repatriated from 56 different countries were autopsied. The interval between death and autopsy in Germany was 2-603 days (median: 11 days). 91 of the repatriated corpses (59.5%) had previously been autopsied abroad. Three body cavities had been opened in 78.0% (71/91) of the original autopsies; among them, there were 11 cases (15.5%) with dissection of all organs, as opposed to 7 cases (9.9%) with all organs intact and in situ. Of the previously autopsied corpses, 62.6% were accompanied by a body passport that noted the cause of death. In nearly 75% of these cases, the stated cause of death was compatible with that established at second autopsy. In 5 cases (10.2%), the cause of death established in the second autopsy disagreed with that on the body passport. The most prominent disparity was a cranial gunshot wound rather than the stated fatal fall. DISCUSSION This analysis of individual cases spotlights the problematics of an uncritical approval of the body passport. In light of the different procedural autopsy standards around the world, the validity of an autopsy abroad is discussed in the context of the second autopsy results. CONCLUSION A second external postmortem examination by qualified medical practitioners should be obligatory in all cases of repatriated corpses, with notification of the criminal police in all cases of non-natural or undetermined death. A timely second autopsy is recommended even in cases with previous autopsy abroad.
Collapse
Affiliation(s)
- F Holz
- Department of Legal Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany.
| | - M F Saulich
- Department of Legal Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - A S Schröder
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C G Birngruber
- Department of Legal Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - M A Verhoff
- Department of Legal Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - S Plenzig
- Department of Legal Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| |
Collapse
|
13
|
|
14
|
Holz F, Verhoff MA, Kettner M, Ramsthaler F, Ohlwärther TEN, Birngruber CG. Lochfrakturen der Schädelbasis durch dislozierte Mandibulaköpfchen. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Holz F, Plenzig S, Held H, Verhoff MA, Birngruber CG. Trisomy 21 in forensic autopsies: Review of a 20-year period. Forensic Sci Int 2019; 297:302-306. [PMID: 30852413 DOI: 10.1016/j.forsciint.2019.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/27/2019] [Accepted: 02/12/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Trisomy 21 is the most common human chromosomal abnormality. Its manifestation includes intellectual impairment and more or less typical anatomical malformations and functional deficiencies that can cause sudden or unexpected deaths. Typical medicolegal questions at autopsy are related to medical malpractice, improper care, neglect, or abuse, and, depending on the cause of death, whether the death might have been avoidable. The aim of this study was to examine whether the causes of death in individuals with trisomy 21 were linked to the known health risks for this condition and to consider how these deaths might have been prevented. MATERIAL AND METHODS A retrospective study was performed at the Institutes for Legal Medicine in Giessen and Frankfurt am Main, Hesse, Germany. All records for forensic autopsy cases within a 20-year period from 1998 to 2017 were reviewed for the diagnosis trisomy 21", respectively, "Down's syndrome". RESULTS Twenty-three cases complied with the inclusion criteria trisomy 21 and autopsy. The age of the deceased ranged from 23 days to 61 years. Infectious diseases, mainly respiratory, were the leading cause of death, followed by accidental deaths. CONCLUSION The medicolegal relevance of the known health risks in Down's syndrome could be illustrated by the autopsy findings and the results of the additional examinations. The known high susceptibility to infections, with an increased risk of a rapid course and lethal outcome, in individuals with Down's syndrome could be confirmed in our study. A sound knowledge of the risks and abnormalities associated with trisomy 21 are helpful in medicolegal assessments, particularly, in relation to medical malpractice charges.
Collapse
Affiliation(s)
- F Holz
- Institute of Legal Medicine, Goethe University, Frankfurt am Main, Germany
| | - S Plenzig
- Institute of Legal Medicine, Goethe University, Frankfurt am Main, Germany
| | - H Held
- Institute of Legal Medicine, Goethe University, Frankfurt am Main, Germany
| | - M A Verhoff
- Institute of Legal Medicine, Goethe University, Frankfurt am Main, Germany
| | - C G Birngruber
- Insitute of Legal Medicine, Justus Liebig University, Giessen, Germany.
| |
Collapse
|
16
|
Hartrampf LCM, Winzek CF, Kampschulte M, Pons‑Kühnemann J, Saternus KS, Dettmeyer R, Birngruber CG. Zur Geschlechts- und Altersabhängigkeit der Ossifikation der Cartilago thyroidea. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0300-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
17
|
Holz F, Birngruber CG, Ramsthaler F, Verhoff MA. Beneath cover-up tattoos: possibilities and limitations of various photographic techniques. Int J Legal Med 2019; 134:697-701. [PMID: 30706194 DOI: 10.1007/s00414-019-02007-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The goal of this study was to investigate the usefulness of various photographic techniques in visualizing previous tattoos under cover-up tattoos. MATERIAL AND METHODS Ten volunteers with 11 known cover-up tattoos were examined using different photographic techniques: A Canon EOS 6D full-frame digital single-lens reflex camera used in conjunction with a SB600 off-camera flash system and an extension cord; and a Leica M8 digital imaging system camera in conjunction with two different infrared filters (715 nm and 850 nm) and a Metz CL-45 handle-mount flash. A Lumatec Superlite 400 forensic light source was used along with the Canon EOS 6D as a third system. RESULTS The best results for black cover-up tattoos were achieved with the full-frame digital single-lens reflex camera in conjunction with the off-camera flash system and, for colored cover-up tattoos, with IR-photography at a wavelength of 850 nm. The Lumatec Superlite 400 light source did not provide better results for conventional photography than those obtained with flash lighting. DISCUSSION In nine out of eleven cover-up tattoos, the previous tattoos could, at least, be partially visualized. The quality of the visualization depended on the color, pattern, density, and quality of the cover-up tattoo as well as on the photographic technique. None of the examined photographic techniques could satisfactorily image the previous tattoo if the cover-up tattoo was large and black, especially not if it was densely inked. CONCLUSION Depending on the color of the cover-up tattoo, a full-frame digital single-lens reflex camera in conjunction with a SB600 off-camera flash system (for black cover-ups) or infrared photography with flash lighting and an 850 nm filter (for colored cover-ups) proved to be the best of the investigated techniques to visualize a previous tattoo under a cover-up tattoo.
Collapse
Affiliation(s)
- F Holz
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Kennedyallee 104, 60596, Frankfurt am Main, Germany.
| | - C G Birngruber
- Institute of Legal Medicine, University Hospital, Justus-Liebig-University, Giessen, Germany
| | - F Ramsthaler
- Institute of Legal Medicine, Saarland University, Homburg, Saar, Germany
| | - M A Verhoff
- Institute of Legal Medicine, University Hospital of Frankfurt, Goethe University, Kennedyallee 104, 60596, Frankfurt am Main, Germany
| |
Collapse
|
18
|
|
19
|
Gille RJ, Ramsthaler F, Thali M, Strunk J, Birngruber CG, Verhoff MA. Osteologische Geschlechtsbestimmung anhand von Gaumenmaßen. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0254-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
20
|
|
21
|
|
22
|
Kettner M, Ramsthaler F, Grabherr S, Heinemann A, Birngruber CG, Verhoff MA. Forensische Bildgebung im deutschsprachigen Raum – eine Bestandsaufnahme. Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0157-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Ramsthaler F, Birngruber CG, Kettner M, Verhoff MA, Burkholder I. Studien und statistische Ergebnisse in der Forensik. Rechtsmedizin (Berl) 2016. [DOI: 10.1007/s00194-015-0063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|