Forensic science international
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Excited delirium (ED) syndrome is a serious medical condition associated with acute onset of agitated violent behavior that often culminates in a sudden unexplained death. While the contribution of restraint, struggle and the use of conductive energy devices (CED) to the cause and manner of death raise controversy, a CNS dysfunction of dopamine signaling may underlie the delirium and fatal autonomic dysfunction. We conducted a mortality review for a case series of ninety excited delirium deaths and present results on the association of a 2-protein biomarker signature. ⋯ The elevation of Hsp70 in autopsy brain specimens confirms that hyperthermia is an associated symptom and often a harbinger of death in these cases. Dopamine transporter levels were below the range of values measured in age-matched controls, providing pathologic evidence for increased risk of chaotic dopamine signaling in excited delirium. When combined with descriptions of the decedents' behavior prior to death, a 2-protein biomarker signature can serve as a reliable forensic tool for identifying the excited delirium syndrome at autopsy.
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A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. ⋯ Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases.
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In patients with gunshot injuries, it is easy to detect a projectile within the body due to the high-density of the object, but artefacts make it difficult to obtain information about the deformation and the exact location of the projectile in surrounding tissues. Cone-beam computed tomography (CBCT) is a new radiological imaging modality that allows radio-opaque objects to be localised and assessed in three dimensions. The full potential of the use of CBCT in forensic medicine has not yet been explored. ⋯ Therefore CBCT is superior in visualising bone destruction in the immediate vicinity of the projectile and projectile deformation, whereas MDCT allows soft tissue to be evaluated in more detail. CBCT is an improved diagnostic tool for the evaluation of gunshot injuries. In particular, it is superior to MDCT in detecting structural hard-tissue damage in the immediate vicinity of high-density metal projectiles and in identifying the precise location of a projectile in the body.