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Schäffer B, Graw M, Dettmeyer R. Rechtsreport. Rechtsmedizin (Berl) 2021. [DOI: 10.1007/s00194-021-00485-6] [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: 10/21/2022]
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Abstract
INTRODUCTION In December 2019, the new infectious coronavirus disease 2019 (COVID-19) first appeared in China. So far, no systematic evaluation of death certificates of COVID-19-associated deaths has been presented. METHODS The death certificates of all deaths in Munich during the period from 1 March to 31 July 2020 were analyzed. The previously defined inclusion criteria were the indication of corona, COVID-19 and SARS-CoV‑2 in the death certificates. The variables were entered anonymously according to a developed key. The collected data were evaluated descriptively. RESULTS In the period under investigation, a total of 5840 people died in the Munich City area. Of these deaths 332 (5.7%) were COVID-19-associated. In 281 deaths (84.6%) there was a definite COVID-19 and in 51 deaths (15.4%) the suspicion of this disease. The most frequent causes of death were acute respiratory distress syndrome or respiratory insufficiency (59.1%), multiple organ failure (21.4%) and sepsis (10%). An average of 1.8 pre-existing illnesses were reported in the death certificates. Most frequently mentioned were diseases of the circulatory system (54.8%), the nervous system (22.8%) and metabolic diseases (18.9%). The average age at death was 79 years and the most frequent place of death was a hospital (85%). An autopsy was attempted by the doctors who issued the death certificates for 18.1% of the collective, most frequently in the case of unexplained or unnatural causes of death and young age of the deceased. Clinical pathological autopsies were performed on 11% of the collective and judicial autopsies on 1%. DISCUSSION This study is the first evaluation of death certificates with respect to the novel infectious COVID-19. Number and essential characteristics of COVID-19-associated deaths in Munich during the so-called first wave could be mapped. The interest of physicians in autopsies was rather low despite the appearance of a new infectious disease.
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Affiliation(s)
- S. Gleich
- Gessundheitsreferat, LH München, Bayerstr. 28a, 80335 München, Deutschland
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M. Graw
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - S. Viehöver
- Gessundheitsreferat, LH München, Bayerstr. 28a, 80335 München, Deutschland
| | - S. Schmidt
- Gessundheitsreferat, LH München, Bayerstr. 28a, 80335 München, Deutschland
| | - D. Wohlrab
- Gessundheitsreferat, LH München, Bayerstr. 28a, 80335 München, Deutschland
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Gleich S, Krüger J, Fels H, Skopp G, Musshoff F, Roider G, Schöpfer J, Graw M, Wiedfeld C. Erratum zu: Medikamente als freiheitsentziehende Maßnahme in stationären Pflegeeinrichtungen? Eine kritische Analyse. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00450-9] [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: 10/22/2022]
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Gleich S, Krüger J, Fels H, Skopp G, Musshoff F, Roider G, Schöpfer J, Graw M, Wiedfeld C. Medikamente als freiheitsentziehende Maßnahme in stationären Pflegeeinrichtungen? Eine kritische Analyse. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00440-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Skopp G, Graw M, Mußhoff F. Medikamente und Fahrsicherheit. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00443-8] [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: 10/23/2022]
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Hofer P, Adamec J, Graw M, Pittner S, Monticelli F, Schöpfer J. Die Ohrfeige. Teil 2 – Verletzungsfolgen und juristische Bedeutung. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-00363-2] [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: 10/25/2022]
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Brodbeck K, Nuspl E, Ertelt-Delbridge C, Graw M, Peldschus S, Schick S. Post-mortem-Nachweis diffuser Axonschäden durch Immunhistochemie. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-00339-2] [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: 11/29/2022]
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Landwehr T, Sinicina I, Graw M. Todesfälle beim Sport. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0311-9] [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: 10/27/2022]
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Zinka B, Bormann C, Graw M, Ackermann I. Morphologische Befunde nach Verstümmelung des weiblichen Genitales. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0238-6] [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]
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Adamec J, Graw M. Schlusswort der Autoren zum Meinungsaustausch zu Halswirbelsäulendistorsionen. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0260-8] [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: 10/28/2022]
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Gerstmann A, Wolst J, Graw M, Holley S. Verwendung von Fußabdruckspuren zur Identifikation. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0234-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: 10/17/2022]
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Adamec J, Bäumler H, Doukoff N, Graw M. Medizinische und rechtliche Aspekte bei der Begutachtung von Halswirbelsäulendistorsionen. Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0155-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gleich S, Domingo O, Ackermann N, Schwerer M, Graw M, Schöpfer J. A post-mortem study of the cause of death and concomitant diseases of refugees in Munich (2014–2015). Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0214-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Gleich S, Viehöver S, Peschel O, Graw M. Woher stammen die Informationen zum Verstorbenen bei der ärztlichen Leichenschau in München? Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0213-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kunz SN, Graw M, Adamec J. A proclaimed accidental fall of an infant-an experimental case reconstruction study. Int J Legal Med 2017; 132:205-210. [PMID: 28803327 DOI: 10.1007/s00414-017-1663-x] [Citation(s) in RCA: 2] [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: 03/14/2017] [Accepted: 08/03/2017] [Indexed: 01/22/2023]
Abstract
The differentiation between a non-accidental injury and injuries resulting from accidents, such as falls to the ground or onto various objects, is a challenge not only for forensic experts but also for all clinicians caring for children. The forensic-biomechanical analysis of accidents in infants aims at the assessment of the loading characteristics based on the reconstruction of the particular incident. It includes an evidence-based analytical comparison between the actual injuries presented and the injuries that should be expected as a result of the proclaimed accident. With the help of kinematical and dynamical parameters of the described actions and the resulting loading situations, the forensic-biomechanical analysis can assess the plausibility of the proclaimed course of the event and thus contribute to the differentiation between accidental and non-accidental injuries. The quality of such a forensic-biomechanical expert opinion depends on the accuracy and quantity of available data regarding biomechanical tolerance of tissues, organs, and body parts. Case-specific measurements can contribute significantly to the insight of the kinematics and dynamics of the proclaimed event, its feasibility, etc. The present article demonstrates, based on one case report, the potential as well as the limits of such an analysis of proclaimed accidental fall injuries.
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Affiliation(s)
- S N Kunz
- Department of Forensic Medicine, Landspítali University Hospital, v/Barónstig, 101, Reykjavik, Iceland.
| | - M Graw
- Institute of Forensic Medicine, Ludwig-Maximillians University, Munich, Germany
| | - J Adamec
- Institute of Forensic Medicine, Ludwig-Maximillians University, Munich, Germany
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Drubba S, Schweitzer S, Penning R, Graw M, Sinicina I, Gleich S. Fentanyl-Verordnungen im Zusammenhang mit Drogenmissbrauch und Drogentodesfällen 2015 in München. Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1601973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Drubba
- Referat für Gesundheit und Umwelt der Landeshauptstadt München, München
| | - S Schweitzer
- Referat für Gesundheit und Umwelt der Landeshauptstadt München, München
| | | | - M Graw
- Institut für Rechtsmedizin, München
| | | | - S Gleich
- Referat für Gesundheit und Umwelt der Landeshauptstadt München, München
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Abstract
Long-term survival after severe trauma is rarely addressed in German trauma journals although knowledge of life expectancy and identification of factors contributing to increased mortality are important for lifetime care management, development of service models, and targeting health promotion and prevention interventions. As reliable data in Germany are lacking, we compiled data mainly from the USA and Australia to describe life expectancy, risk factors, and predictors of outcome in patients experiencing traumatic spinal cord injury, traumatic brain injury, and polytrauma. Two years after trauma, life expectancy in all three categories was significantly lower than that of the general population. It depends strongly on severity of disability, age, and gender and is quantifiable. Whereas improvements in medical care have led to a marked decline in short-term mortality, surprisingly long-term survival in severe trauma has not changed over the past 30 years. Therefore, there is need to intensify long-term trauma patient care and to find new strategies to limit primary damage.
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Affiliation(s)
- W Mutschler
- Klinik für Allgemeine Unfall- und Wiederherstellungschirurgie, Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland.
| | - M Mutschler
- Klinik für Orthopädie,Unfallchirurgie und Sporttraumatologie, Kliniken der Stadt Köln, Universität Witten-Herdecke Campus Köln-Merheim, Köln, Deutschland
| | - M Graw
- Institut für Rechtsmedizin, Ludwig-Maximilian-Universität München, München, Deutschland
| | - R Lefering
- Institut für Forschung in der Operativen Medizin, Universität Witten-Herdecke,Campus Köln-Merheim, Köln, Deutschland
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Trottmann M, Sroka R, Braun C, Liedl B, Schaaf H, Graw M, Becker AJ, Stief CG, Khoder WY. Micro-endoscopy of the human vas deferens: a feasibility study of a novel device in several ex vivo models. Andrology 2016; 5:75-81. [PMID: 27860356 DOI: 10.1111/andr.12282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/17/2016] [Revised: 07/17/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
The aim of this study was to show limitation as well as potential of micro-endoscopy techniques as an innovative diagnostic and therapeutic approach in andrology. Two kinds of custom-made micro-endoscopes (ME) were tested in ex vivo vas deferens specimen and in post-mortem whole body. The semi-rigid ME included a micro-optic (0.9 mm outer diameter [OD], 10.000 pixels, 120° vision angle [VE], 3-20 mm field depth [FD]) and an integrated fibre-optic light source. The flexible ME was composed of a micro-optic (OD = 0.6 mm, 6.000 pixels, 120° VE, 3-20 mm FD). The ex vivo study included retrograde investigation of the vas deferens (surgical specimen n = 9, radical prostatectomy n = 3). The post-mortem investigation (n = 4) included the inspection of the vas deferens via both approaches. The results showed that antegrade and retrograde rigid endoscopy of the vas deferens were achieved as a diagnostic tool. The working channel enabled therapeutic use including biopsies or baskets. Using the flexible ME, the orifices of the ejaculatory ducts were identified. In vivo cadaveric retrograde cannulation of the orifices was successful. Post-mortem changes of verumontanum hindered the examinations beyond. Orifices were identified shaded behind a thin transparent membrane. Antegrade vasoscopy using flexible ME was possible up to the internal inguinal ring. Further advancement was impossible because of anatomical angle and lack adequate vision guidance. The vas deferens interior was clearly visible and was documented by pictures and movies. Altogether, the described ME techniques were feasible and effective, offering the potential of innovative diagnostic and therapeutic approaches for use in the genital tract. Several innovative indications could be expected.
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Affiliation(s)
- M Trottmann
- Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - R Sroka
- Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany.,LIFE Centre, University Hospital of Munich, Munich, Germany
| | - C Braun
- Department for Forensic Medicine, University of Munich, Munich, Germany
| | - B Liedl
- Department of Urogenital Surgery, Clinics for Surgery Munich-Bogenhausen, Munich, Germany
| | - H Schaaf
- Polydiagnost GmbH, Hallbergmoos, Germany
| | - M Graw
- Department for Forensic Medicine, University of Munich, Munich, Germany
| | - A J Becker
- Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - C G Stief
- Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany
| | - W Y Khoder
- Department of Urology, Klinikum Grosshadern, University of Munich, Munich, Germany
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Gleich S, Schweitzer S, Graw M, Kraus S. Die ärztliche Leichenschau – Zur Qualität ausgestellter Todesbescheinigungen aus Sicht eines Großstadtgesundheitsamtes. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1578834] [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: 10/22/2022]
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Holley S, Peschel O, Graw M. Angewandte Kindermodelle in der passiven Fahrzeugsicherheit. Rechtsmedizin (Berl) 2016. [DOI: 10.1007/s00194-015-0055-0] [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: 11/28/2022]
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Fiedler S, Berns A, Schwark L, Woelk A, Graw M. The chemistry of death – Adipocere degradation in modern graveyards. Forensic Sci Int 2015; 257:320-328. [DOI: 10.1016/j.forsciint.2015.09.010] [Citation(s) in RCA: 8] [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] [Received: 03/18/2015] [Revised: 05/14/2015] [Accepted: 09/12/2015] [Indexed: 10/23/2022]
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Affiliation(s)
- Bettina Zinka
- Institut für Rechtsmedizin der LMU, München, Deutschland,
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Krueger J, Sachs H, Musshoff F, Dame T, Schaeper J, Schwerer M, Graw M, Roider G. First detection of ethylphenidate in human fatalities after ethylphenidate intake. Forensic Sci Int 2014; 243:126-9. [DOI: 10.1016/j.forsciint.2014.07.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 06/18/2014] [Accepted: 07/15/2014] [Indexed: 11/30/2022]
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Kettner M, Graw M, Schmidt P. Moderne Technologien in der forensischen Anthropologie. Rechtsmedizin (Berl) 2013. [DOI: 10.1007/s00194-013-0872-y] [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]
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Fiedler S, Breuer J, Pusch CM, Holley S, Wahl J, Ingwersen J, Graw M. Graveyards - special landfills. Sci Total Environ 2012; 419:90-7. [PMID: 22285086 DOI: 10.1016/j.scitotenv.2011.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/24/2011] [Accepted: 12/03/2011] [Indexed: 05/24/2023]
Abstract
Graveyards have been a matter of controversial debate for many years in terms of the risk they pose to the environment. However, literature data are inconclusive and there are no systematic studies available from modern graveyards with special reference to soil found in the vicinity of the coffin. To our knowledge, the present study is the first to systematically investigate a comprehensive exhumation series (involving 40 graves) in order to determine burial-related changes in matter and element content. Human burials lead to the accumulation of certain elements, with higher than normal levels of N, C, Zn, Ba, Ca and Na being observed in soils below coffins. Decomposition material inside coffins has much higher levels of heavy metals and alkaline elements than the surrounding soil. However, the major problem observed was the large quantity of synthetic bedding material which is more likely to lead to the formation of adipocere under the moist conditions given. Adipocere formation, which is the result of the anaerobic bacterial hydrolysis of fat, is known to interrupt the natural decomposition process and delay the post-mortem release of elements. We assume that once the inhumed matter has completely decomposed, much higher than normal levels of pollutants will be released into and have an ecological effect on the soil and water environment.
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Affiliation(s)
- S Fiedler
- Institute of Soil Science and Land Evaluation, University of Hohenheim, Emil-Wolff-Straße 27, 70599 Stuttgart, Germany.
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Thieme D, Große J, Keller L, Graw M. Urinary concentrations of ethyl glucuronide and ethyl sulfate as thresholds to determine potential ethanol-induced alteration of steroid profiles. Drug Test Anal 2011; 3:851-6. [DOI: 10.1002/dta.396] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- D. Thieme
- Institute of Doping Analysis; Dresden; Germany
| | - J. Große
- Institute of Doping Analysis; Dresden; Germany
| | - L. Keller
- Institute of Legal Medicine; University of Munich; Germany
| | - M. Graw
- Institute of Legal Medicine; University of Munich; Germany
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Kunz SN, Adamec J, Zinka B, Münzel D, Noël PB, Eichner S, Manthei A, Grove N, Graw M, Peschel O. Wound ballistic evaluation of the Taser® XREP ammunition. Int J Legal Med 2011; 127:119-26. [PMID: 21984167 DOI: 10.1007/s00414-011-0628-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 09/26/2011] [Indexed: 11/30/2022]
Abstract
The Taser® eXtended Range Electronic Projectile (XREP®) is a wireless conducted electrical weapon (CEW) designed to incapacitate a person from a larger distance. The aim of this study was to analyze the ballistic injury potential of the XREP. Twenty rounds were fired from the Taser®X12 TM shotgun into ballistic soap covered with artificial skin and clothing at different shooting distances (1-25 m). One shot was fired at pig skin at a shooting distance of 10 m. The average projectile velocity was 67.0 m/s. The kinetic energy levels on impact varied from 28-52 J. Depending on the intermediate target, the projectiles penetrated up to 4.2 cm into the ballistic soap. On impact the nose assembly did not separate from the chassis, and no electrical activation was registered. Upon impact, a skin penetration of the XREP cannot be excluded. However, it is very unlikely at shooting distances of 10 m or more. Clothing and a high elasticity limit of the target body area can significantly reduce the penetration risk on impact.
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Affiliation(s)
- Sebastian N Kunz
- Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, Munich, Germany.
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Moschkau N, Kunz S, Fieseler S, Graw M, Zinka B. Sektionsdaten des Instituts für Rechtsmedizin der Universität München aus dem Jahr 2003. Rechtsmedizin (Berl) 2011. [DOI: 10.1007/s00194-011-0788-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Fischer F, Grimm J, Kirchhoff C, Reiser MF, Graw M, Kirchhoff S. Postmortem 24-h interval computed tomography findings on intrahepatic gas development and changes of liver parenchyma radiopacity. Forensic Sci Int 2011; 214:118-23. [PMID: 21862251 DOI: 10.1016/j.forsciint.2011.07.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 07/11/2011] [Accepted: 07/18/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to assess and analyze the development of intrahepatic gas and its distribution over time as well as radiopacity changes of the liver parenchyma after non-traumatic death during a period of 24h using postmortem computed tomography (PMCT). MATERIALS AND METHODS Five male corpses (age range 24-64 yrs) who had died for any other reason than trauma were enrolled in this study. Whole body multi detector row computed tomography (MDCT) scans (Brilliance 64-channel, Philips, Amsterdam, NL) were performed for 24 h with one examination per hour. At an average of 6h after the corpses were found on scene the first CT-exam took place. For the analysis of the intrahepatic gas development and distribution within 24h after death the liver was virtually divided into four parts. Each examination was analyzed for gas bubbles and the possible increase over time using a semiquantitative/visual assessment employing a four-grade scale. The changes of the radiopacity of the liver parenchyma were assessed in a similar way. In each of the four parts of the liver three regions of interest of the same size were placed and recorded over time. Three radiologists and one coroner independently performed the analysis of the gas development and radiopacity changes. RESULTS In two corpses the amount of gas and its distribution did not change over the observation period whereas in the other three corpses the gas content increased within the first four to seven hours and was most pronounced in the left liver lobe and least in the right posterior liver lobe. In all five corpses the radiopacity of the liver parenchyma did not change significantly over time with the highest radiopacity in the right posterior liver lobe. Good interobserver reliability concerning the assessment of intrahepatic gas accumulation was found. DISCUSSION Our results indicate that PMCT is useful to detect intrahepatic gas. However, several reasons for these findings besides putrefaction e.g. trauma, resuscitation exist. For an elucidation of the exact causation of the gas accumulation further studies are required with longer postmortem examination times (24-72 h) to detect more pronounced changes of gas and organ radiopacity but also an earlier start of examination after death is desirable. Moreover, it has to be elucidated whether other organs exhibit a similar behavior and how temperature of the CT-room and the body impacts on these parameters.
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Affiliation(s)
- F Fischer
- Institute of Forensic Medicine, Ludwig-Maximilians-Universitaet Muenchen, Muenchen, Germany
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Fieseler S, Pfandzelt S, Zinka B, Kunz S, Gabriel H, Eisenmenger W, Graw M. Der Einsame Tod - Sterben in Randgruppen in München. Gesundheitswesen 2010; 72:859-65. [DOI: 10.1055/s-0029-1246120] [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: 10/19/2022]
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Fischer F, Graw M. [Use of short acting sedatives: how to minimise forensic risks]. MMW Fortschr Med 2009; 151:34-35. [PMID: 19475854] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- F Fischer
- Institut für Rechtsmedizin der Ludwig-Maximilians-Universität München
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Kipshagen T, Graw M, Tronnier V, Bonsanto M, Hofmann UG. Touch- and marker-free interaction with medical software. IFMBE Proceedings 2009. [DOI: 10.1007/978-3-642-03906-5_21] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Rösing FW, Graw M, Marré B, Ritz-Timme S, Rothschild MA, Rötzscher K, Schmeling A, Schröder I, Geserick G. Recommendations for the forensic diagnosis of sex and age from skeletons. Homo 2007; 58:75-89. [PMID: 17306261 DOI: 10.1016/j.jchb.2005.07.002] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 07/17/2005] [Indexed: 11/29/2022]
Abstract
In both diagnostic fields a two-stage strategy is recommended: to first use "field" methods that are quick and easy but more imprecise and then "laboratory" methods that are time consuming but more precise. In preparing skeletal work, individuality of a skeleton should be checked, traces of diseases sought and time since death assessed. For sexing non-adults, the field methods are tooth mineralisation, long bone length and a few morphological skull and pelvis characteristics, for adults it is the morphology of pelvis and skull, and for both age groups the advanced laboratory method is molecular biology. For ageing non-adults the methods are mineralisation of teeth, long bone length and epiphysis development. For ageing adults the advanced laboratory method is aspartic acid racemisation. Less accurate laboratory methods are cement ring counts and histology of bones and teeth. Quick morphological methods using the pubic symphysis and other traits in combinations follow. Finally, cranial sutures and tooth number give a quick and rough impression. For the selection of a method and the assessment of its value the stochastic error produced for the reference sample is the decisive criterion; it should also be used to assess the reliability of a single diagnosis. Prerequisites for all work with skeletons are not only a complete knowledge of the relevant biology as well as specific techniques but also initial detailed instructions and with forensic applications, personal experience.
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Affiliation(s)
- F W Rösing
- Institut für Humangenetik und Anthropologie, Universität Ulm, Germany.
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Abstract
We report the case of a 33-year-old transsexual man who developed severe sepsis after an accidental intravenous injection of urine (3-5 ml) instead of methadone. He died unexpectedly 28 days after the onset of sepsis. On postmortem examination, the outstanding findings were restricted to the heart with an unusual macroscopic presentation. On histological examination extensive calcifications of the heart muscle, particularly of the left ventricle were found. The pattern of calcifications on the right ventricle was also striking. In contrast, the entire cardial conduction system was unaffected. Furthermore, there were no calcium deposits in other organs and tissues. The advanced widespread cardial calcifications in the present case can be attributed to endotoxin-related myocarditis in severe long-term sepsis. The only treatment would have been an urgent heart transplantation. Without prior knowledge of such a condition, it is impossible for clinicians to correctly recognize, diagnose and treat or prevent in due time such a complication.
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Affiliation(s)
- I Sinicina
- Department of Forensic Medicine, Ludwig Maximilians University Munich, Frauenlobstr. 7 a, 80337 Munich, Germany.
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Rösing FW, Graw M, Marré B, Ritz-Timme S, Rothschild MA, Rötzscher K, Schmeling A, Schröder I, Geserick G. [ Recommendations for the forensic and age determination from the skeleton]. Anthropol Anz 2005; 63:221-32. [PMID: 15962573] [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] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- F W Rösing
- Institut für Humangenetik und Anthropologie, Universitätsklinikum, Ulm.
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Muggenthaler H, Praxl N, Schönpflug M, Adamec J, von Merten K, Peldschus S, Schneider K, Graw M. Oberflächenelektromyographie. Rechtsmedizin (Berl) 2005. [DOI: 10.1007/s00194-005-0324-4] [Citation(s) in RCA: 3] [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: 11/30/2022]
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