Biomedical subjects

B Karger

Publications and source records attributed to B Karger.

At least 37 records · Page 2Linked to original sources

PubMed2001

Suicide by more than 90 stab wounds including perforation of the skull.

A man committed suicide in his bathroom using a small pocket knife. At the autopsy a total of 92 stab wounds on the forehead, in both temples, the anterior aspect of the neck, the back of the neck, the chest and the sides of the trunk were found. In addition, repeated stabbing had caused a large soft tissue defect on the forehead. The frontal bone showed 3 perforations but no brain injury was present and two ribs were severed in the bony part, one of which carried a star-like pattern from repeated stabbing. No major vessels were injured and the cause of death was exsanguination after a considerable survival time. The large number of stab wounds, the perforation of bone and some injury sites, especially the head and back of the neck, are extraordinary findings in suicides which were probably favoured by insufficient anatomical knowledge and the use of a short-bladed knife. A psychiatric history could not be verified.

Adult↗

PubMed2001

Proof of a gunshot wound and its delayed effects 54 years post injury.

In 1945 a 6-year-old girl received a tangential gunshot injury to the left posterior inferior skull. After hospitalisation because of septicemia she was unable to walk for several months. Since 1967 she had been repeatedly applying for compensation because of pseudoneurasthenia and residual ataxia and many medical examinations were performed including X-ray, CT and MRI. Although certain objective findings (e. g. cerebellar atrophy) could be verified, a causal connection between the gunshot injury and the clinical findings could not be established. Therefore previous investigators concluded on a vascular origin of the disease. During the present re-examination of the patient, the authors found patch-like scars at the left posterior inferior skull base and behind the left ear, a cord-like scar formation in the subcutaneous tissue, connecting both skin scars, a gutter-like defect in the left occipital base of the skull and an indention of the left mastoid process, both again in line between the skin scars and a large defect of the left cerebellar hemisphere. It could be concluded with certainty that the anatomical findings and the clicinal symptoms were the direct result of a gunshot injury. Previous investigations had failed because of deficient investigations and techniques. In addition to an anatomical reconstruction, three dimensional reconstructions from CT scans proved most helpful.

Ataxia↗

PubMed2001

DNA analysis of abortion material assisted by histology screening.

In cases of rape leading to fertilization, paternity testing can retrospectively identify the assailant. Abortion material commonly represents a mixture of maternal and fetal tissue and blood, which cannot be differentiated with the naked eye. Consequently, DNA typing of abortion material may be complicated, including band overlap if maternal tissue predominates. Therefore, histology screening of the abortion content for typical fetal tissue components, such as chorionic villi, followed by selected DNA typing of this sample is suggested. This combined approach is illustrated by a selected case demonstrating the reliability and concurrence of the histology and genetic results.

Abortion, Induced↗

PubMed2000

Relationship between impact velocity and injuries in fatal pedestrian-car collisions.

The most common type of fatal pedestrian-car collision, i.e. a passenger car with a wedge or pontoon shaped front striking an erect adult with this front, was investigated. A reliable calculation of the impact velocity range by a technical expert and a comprehensive autopsy suitable for traffic accidents were performed in every case. A total of 47 fatalities form the material of this study and the impact velocities varied between 18 and 142 km/h. Primary and secondary injuries did not show a relationship to impact velocity. The occurrence of four types of indirect injuries revealed a clear relationship to impact velocity, i.e. spinal fractures, ruptures of the thoracic aorta, inguinal skin ruptures and dismemberment of the body. Important parameters such as the type of car, impact velocity range and indirect injuries are listed for each individual case. Because of the limited number of cases, the impact velocity ranges (3-30 km/h) instead of mean values were considered. A cautious interpretation of the data can be summarised in the following conclusions: If there is no spinal fracture, the velocity was below 70 km/h and probably below 50 km/h. Aortic and inguinal skin ruptures are always present if the velocity was above 100 km/h but never occurred below 50-60 km/h. If dismemberment occurs, the velocity was above 90 km/h. Consequently, an estimation of the impact velocity from the presence or absence of indirect injuries is possible in pedestrian-car collisions of the type examined. However, the selection criteria applied in this study and additional parameters influencing the collision dynamics have to be considered carefully.

Accidents, Traffic↗

PubMed2000

Criminal anticipation of DNA investigations resulting in mutilation of a corpse.

A corpse of a female was found in her apartment in a state of advanced putrefaction. Both hands were amputated, the external genitals were excised and the body parts had been removed from the scene. The subsequent investigations proved that the body parts had been severed post mortem. The cause of death was determined to be manual strangulation. A 33-year-old man later confessed that he had strangled the victim 9 days prior to discovery of the body and that he had had sexual intercourse post mortem. According to the confession, the rational motive for the subsequent mutilation was to eliminate biological stains (e.g. semen inside the vagina, epithelial cells below the fingernails from scratching) suitable for forensic DNA analysis. This constitutes a new type of defensive mutilation intended to prevent the identification of the perpetrator. An increase in the occurrence would be detrimental to the elucidation rate of homicides: in a total of 171 homicides investigated at this institute, DNA analysis of biological stains gave reliable evidence in 45 cases.

Adult↗

PubMed2000

Suicides by sharp force: typical and atypical features.

A total of 65 consecutive cases of suicide by sharp force were investigated by evaluating the autopsy and prosecution department records. Suicides constituted 17% of all fatalities from sharp force autopsied between 1967 and 1996. Young males and persons with a psychiatric history predominated among the persons who chose this "hard" method of suicide. The most common implements used were knives (62%) and razor blades (15%). Cutting injuries in isolation were present in 26, stab injuries in isolation in 24 and a combination of both in 15 fatalities. The number of injuries per case varied from 1 to 37 but 1/3 showed one injury. More than 85% of the cutting injuries were located at the wrist, elbow crease or neck whereas 79% of the stab injuries involved the ventral aspect of the trunk. Perforation of clothing was present in 16 (52%) out of 31 stab injuries to the trunk. Injuries to more than one body region were observed in 34 (52%) cases. Tentative marks were present in 50 (77%) fatalities and the number varied from 1 to 60 per case. Superficial incisions of the fingers were found in 15% with razor blades constituting the weapon in half of these cases. Deviations from these typical patterns occurred not infrequently. The utter determination of the victim to carry it through or the use of unusual weapons resulted in a few bizarre cases which are outlined briefly.

Abdominal Injuries↗

PubMed1999

Injuries from hand grenades in civilian settings.

Four cases of hand grenade detonations in civilian life with homicidal intent are reported. The detonations always occurred in close proximity to the victims but there were only two fatalities out of seven victims directly attributable to the hand grenades. The relatively low mortality rate results from the ballistic characteristics of hand grenade missiles such as low mass and sectional density. This leads to rapid deceleration and thus to a poor penetration capacity of intermediate targets and tissue. Window glass at a distance of 2 m was not perforated in one case and the vast majority of fragment wounds showed a short wound tract of small diameter. The potential for physical activity can be unaffected even after a detonation inside a car. However, body parts almost in contact with the hand grenade, such as in a struggle, suffer large lacerations and comminuted fractures. At a distance, the chance of striking a vulnerable body region is increased by the multiple missiles but the wounding potential clearly decreases with increasing distance due to rapid deceleration and decreasing fragment cloud density. The effective range of detonation shock waves from hand grenades is very short and can only contribute to wounding in close-to-contact detonations. The forensic reconstruction is based on the directed radial character of the forces generated and on the sharply decreasing intensity of these forces with increasing distance from the detonation.

Autopsy↗

PubMed1999

Physical activity following fatal injury from sharp pointed weapons.

Cases of suicide from sharp pointed weapons (n = 12) witnessed by one or more persons are reported with regard to the potential for physical activity. One case each involved the ulnar artery, the great saphenous vein and the periphery of the lung and liver and the physical activity following these injuries lasted for several hours. In one case, the left carotid and vertebral arteries were transected and the physical activity lasted for approximately 10 s. An extraordinary case involved a protracted incapacitation due to heart tamponade from a small myocardial injury caused by a cannula. In the remaining seven cases, a stab wound to the heart was present. With regard to the physical activity, a long-term group (2-10 min, n = 4) can be differentiated from a short-term group (approximately 10 s, n = 2) and one case of immediate incapacitation. The size of the myocardial perforation was 7-10 mm in length in the long-term group compared to 1.4-2 cm in the short-term group. So small perforations of the heart or incisions of the carotid artery offer a potential for considerable physical activity. Large perforations of the heart or a transection of the carotid and vertebral arteries can result in short-term activity.

Adult↗

PubMed1999

Fatal brain injury caused by the free-flying blade of a knife - case report and evaluation of the unusual weapon.

A man suffered a fatal injury from a self-inflicted accident while handling a special type of knife. A spring in the shaft of the knife accelerated the blade, which perforated the orbital cavity and the frontal lobe at the right side. Death was due to central disregulation. The initial velocity of the blade was measured to be 15 m/s. In a total of 20 experimental shots to a fresh pig cadaver, the blade always penetrated the skin and 5-10 cm of soft tissue as long as the distance did not exceed 1 m. Thin layers of bone were also perforated. The free flight of the blade did not remain stable if the distance was more than 1 m, which resulted in superficial wounds only. So this unusual construction resembling a knife can be considered an effective combat weapon for close range fighting instead of a tool.

Accidents↗

PubMed1998

Fatalities from black powder percussion handguns.

Three suicides and one homicide from black powder muzzle loading handguns are reported and the muzzle velocities of two weapons are recorded. The fatal head shots caused wide wound tracts traversing the brains and intracerebral haemorrhages remote from the tract were present in every case. The skulls showed considerable fractures which were pronounced in the cases of contact shots but were also present when the range of fire was 5 m. These extensive injuries from soft lead spheres with muzzle velocities of only approximately 200 m/s are attributed to the expansion of the spheres. The regularly occurring deformation resulted in 13-16 mm calibre missiles in the cases of .44 spheres. The special features of black powder such as incomplete and slow combustion resulted in intense soot deposits in the vicinity of the entrance wound and in long ranges the gunshot residues travelled. In contact shots, large pocket-like underminings even in deeper tissue layers, abundant soot along the trajectory and skin burns were observed.

Adult↗

PubMed1998

Experimental bloodstains on fabric from contact and from droplets.

The differentiation between contact bloodstains and stains produced by projected droplets on fabric can be crucial in crime scene reconstruction since suspects can explain bloodstains on their clothing by contact with the victim post mortem. Experimental smear and contact pressure stains on three different types of fabric were compared with stains produced by falling and projected droplets ("dynamic" stains) of equivalent size. The morphology of the small stains (0.1-10 microliters) was investigated with a macroscope. Characteristic for "dynamic" stains are symmetry and rhythmicity (secondary droplets) of the stain and a zonal drying pattern. Contact stains lack the characteristic features of "dynamic" stains and show a clear impregnation of the material resulting in a blood-soaked reverse side of cambric and cotton and in a paler overall colour. The mode of formation of microstains (blood volume 1 < microliter) on irregular surfaces (e.g. terry cloth) can be difficult to determine since the rough surface structure and the small blood volume reduce the characteristics of dynamic stains. In these cases, comparison with experimental stains on the same surface material is recommended.

Blood Stains↗

PubMed1998

Fatal wounds to the thorax caused by gunshots from blank cartridges.

Lethal injuries of the thorax due to shots fired from blank cartridges calibre 8 mm are reported in three cases. The muzzle of the weapon was in contact with the left side of the breast (contact discharge) and injuries to bones were absent in all three cases. In two of the cases the pericardium was not involved but the anterior wall of the right heart ventricle was ruptured and death was due to cardiac tamponade. In the third case the pericardial sac and the left ventricle were both ruptured and the victim died due to rapid exsanguination. The cases demonstrate that the gas pressure from the exploding propellent of blank ammunition can be powerful enough to penetrate the thoracic wall.

Adolescent↗

PubMed1998

Ketoacidosis and lactic acidosis--frequent causes of death in chronic alcoholics?

In clinical medicine, severe keto- or lactic acidosis associated with vomiting, nausea, abdominal pain, tachycardia or pathological respiration, has been described in chronic alcoholics. This study reports on fatalities of chronic alcoholics where the cause of death could not be determined by thorough autopsy, histology and toxicology including determination of alcohol concentration. In a first series, acetone was determined in the blood of such chronic alcoholics (n = 24), diabetics with metabolic decompensation (n = 7), cases of hypothermia (n = 7) and controls (n = 218). Among the 24 chronic alcoholics where the cause of death was unknown, 9 cases showed very high levels of acetone (74-400 mg/l). These comprised 6 cases without additional findings and 3 cases where a second patho-mechanism such as intoxication possibly contributed to the cause of death. In a second series, the sum values according to Traub (lactate/glucose) were determined in cerebrospinal liquor of chronic alcoholics with undetermined cause of death (n = 45), diabetics (n = 6) and controls (n = 39). Among the 45 alcoholics, 17 cases showed very high sum values (294-594 mg/dl) including 8 cases where non-lethal intoxications may have contributed to the final outcome. Other causes of a ketoacidosis or lactic acidosis (e.g. diabetes) were excluded in both groups of alcoholics. Consequently, ketoacidosis and lactic acidosis can be the cause of death of chronic alcoholics in a considerable number of cases where no pathomorphological or toxicological changes are present. A scheme for medical and laboratory examination is described.

Acetone↗

PubMed1998

Morphological findings in the brain after experimental gunshots using radiology, pathology and histology.

The tissue disruption inside the brain after experimental gunshots to the head was investigated with special reference to secondary bone missiles and intracranial pressure effects such as cortical contusion and deep intracerebral haemorrhages. The evidential value of various examination methods is compared. 9 mm Parabellum ammunition was fired to the temporal region of calves (n = 10) from a distance of 0-10 cm. Plain film radiography, CT, MRI, visual inspection and histology were performed on every brain. The tissue disruption of the permanent tract is delineated best by artefact-free MRI. Cortical contusions and deep intracerebral haemorrhages were detected infrequently by visual inspection and imaging techniques although they were present in every brain as verified by histology. These injuries remote from the tract increase cerebral wounding compared to non-confined tissue. In particular, the brain stem and central areas were frequent sites of haemorrhages, which can be expected to have serious and immediate consequences. Ectopic bone fragments were found in all brains using CT scans. Bone fragments were located inside clearly enlarged permanent tracts or were driven into brain tissue. In the latter cases, secondary shot channels up to 4 cm in length could be verified by histology. Cortical contusions and intracerebral haemorrhages can only be detected reliably by histology. The localization of bone fragments requires CT scans. Therefore, a detailed examination is accomplished best by a combination of the methods applied in this study.

Animals↗

PubMed1998

Attempted homicide by electrocution.

Attempted homicide by the application of a high-voltage, low-amperage current is reported in an elderly male. An electrician constructed an apparatus and applied the current to wet towels placed on the abdomen of the victim sleeping next door. The attempt was unsuccessful and resulted in burns only. The victim was hospitalised and died 3 weeks later. A causal connection could not be established between the attempted electrocution and the demise of the victim.

Aged↗

PubMed1998

Multiple entrance wounds from one bullet due to the use of a silencer.

When a bullet strikes an interposed object before entering a body, the bullet may fragment, or particles from the interposed object may be accelerated. Such secondary missiles may cause multiple entrance wounds if a body is located in line with their flight path. In the unusual case reported here, a silencer acted as an interposed object. The bullet disintegrated completely after impact with the central part of the silencer baffles, which were misaligned. Some bullet fragments were retained inside the silencer, and some exited as a collection of missiles, comparable to shotgun pellets. From a distance of several meters, the fragments wounded the victim at seven different anatomic sites. Use of a silencer should be considered when bullet fragments are recovered from a scene or victim but no other appropriate interposed object is found.

Firearms↗

PubMed1998

Experimental arrow wounds: ballistics and traumatology.

OBJECTIVE: To provide information on the ballistics and the wounding potential of different arrows or bolts fired from different weapons and to investigate the suitability of simulant media for experimental arrow wounds. METHODS: A longbow, a compound bow, and a crossbow were used to fire a variety of modern and ancient arrows. Fresh corpses of four adult pigs (47 shots) and blocks of gelatin and soap (48 shots) were used as target media, and the resulting wound tracts were examined. The range of fire was 8 m and the velocity was recorded at a distance of 3 m (and 16 m in additional shots) by light screen devices. RESULTS: The mean velocities recorded ranged from 45 m/s (longbow) to 67 m/s (compound bow). The excellent exterior ballistics of arrows results in only a small initial decrease in velocity of O.10 to 0.18 m x s(-1) x m(-1). The penetration depths were reproducible for the same arrowhead fired into the same simulant medium but differed considerably when compared with those in soft tissue. In nonbone tissue, the penetration depth was substantial (17-60 cm) and depended on velocity and especially on the type of arrowhead. All arrows penetrated deeply into the large body cavities and injured organs as long as no thick bone had to be perforated. Flat bones such as ribs were always perforated. Extraction of arrowheads from thick bone proved to be difficult in some cases. The wounding mechanism was a combination of incision and puncture, which facilitated deep penetration of tissue and produced clean-cut wounds. CONCLUSION: Gelatin and soap are not suitable for experimental arrow wounds. Every arrow wound carries a lethal potential. The severity of the wound depends primarily on the target area and the type of arrowhead. Extraction of arrowheads from thick bone has to be performed carefully.

Animals↗

PubMed1997

Backspatter from experimental close-range shots to the head. II. Microbackspatter and the morphology of bloodstains.

Backspatter is the ejection of biological material from a gunshot entrance wound against the line of fire. Backspatter of blood was investigated experimentally in transverse gunshots to the heads of calves (n = 9) from shooting distances of 0-10 cm. The resulting bloodstains were documented on white paper placed horizontally 60 cm below the impact site. The morphology of bloodstains and the distribution of microstains (diameter < 0.5 mm) is reported. The number of microbackspatter stains per gunshot varied between 39 and 262 and the maximum travelling distance was 69 cm while the vast majority of micro-droplets accumulated between 0 and 40 cm. The direction a single droplet can take comprises every possible angle between the most tangential ones to the skin surface. Microstains exclusively were circular to slightly oval. The morphology of macrobackspatter stains (diameter > 0.5 mm) varied from round to elongated with circular, drop-like and stains in the form of exclamation marks predominating. Small macrostains (0.5-4 mm) made up more than 90% of the macrostains and no systematic relationship between distance travelled and size of the stains could be established. The necessity of appropriate lighting and magnification in the investigation of surfaces for backspatter is stressed because many microstains are located in the proximity of the entrance wound where the firearm and the shooting hand are located in cases of close-range shots.

Blood Stains↗