Selbstverstümmelungen in der privaten unfallversicherung

Zusammenfassung Selbstbeschädigungen können in Gruppen klassifiziert werden. Eine würde sich mit der Vortäuschung von Krankheiten, andere mit dem Vorgehen selbst befassen: Einsatz chemischer, thermischer, mechanischer Methoden.Ein Sektor betrifft Verstümmelungen. Auch diese sind aus der Sicht eines Psychiaters gesehen interessant; weit wichtiger jedoch scheint zunächst zu sein, Fragen der Beweisführung nachzugehen.Im Krieg, selbst beim Wehrdienst in Friedenszeiten, bringen sich Soldaten verstümmelnde Verletzungen bei. Diese sind motiviert in der Vorstellung, persönliche Vorteile zu erreichen.Wirtschaftliche Vorteile spielen bei Versicherungsnehmern im Rahmen der Privaten Unfallversicherung eine Rolle: Vortäuschung eines Unfalls mit den Folgen einer Selbstverstümmelung.Ausgangspunkt bildete die Bearbeitung von 123 Fällen unter den Aspekten: Lebensalter, Geschlecht, Beruf, Wohnort, Ort wie Zeitpunkt des Geschehens, Methode des Vorgehens (Tatinstrument), Lokalisation, Einfach- wie Mehrfachverletzungen, Verletzungsrichtung, Haltung der Finger z.B., Beschaffenheit der Wundränder.Ob eine Verletzung freiwillig oder unfreiwillig erfolgte, kann nur durch Hilfstatsachen entschieden werden. Zu klären ist, ob die vom Verletzten angegebene Schilderung eines Hergangs mit Lage, Ort, Richtung der Verletzung in Einklang zu bringen ist bzw. welche Angaben über den Tatort gemacht werden.Der Gutachter sollte nicht beziehungslos ärztliche Befunde interpretieren, sondern lediglich von der Basis: Ablaufschilderung des Ansprucherhebenden, ausgehen.Eine Generalstabsarbeit ist gewissermaßen zu leisten, um sorgsam durchgeführte ärztliche Befunderhebungen den Verletzungen gegenüberzustellen.Ist eine Verletzung durch ein bestimmtes Werkzeug beigebracht, müssen Kenntnisse z.B. über den Sägeunfall und die Beurteilung derartiger Verletzungen vorliegen (Verwertung klinischen Materials) bzw. Leichenversuche vorgenommen werden. Letztere geben Auskunft über mechanisch-physikalische Probleme. Bei der Abklärung der Verletzungsrichtung sind nicht nur die ärztlichen, röntgenologischen, sondern auch rasterelektronen-mikroskopische Untersuchungen unter Einschluß einer spurenkundlichen Expertise in die Begutachtung einzuschließen.Bei geringstem Verdacht einer Selbstbeschädigung sollten unverzüglich entsprechende Untersuchungen in Angriff genommen werden.Nur der sollte Stellung beziehen, wer sich sehr intensiv mit diesem, forensisch so interessanten, Spezialgebiet befaßt hat.

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Self-mutilations in private-accident-insurance cases

Summary Self-inflicted injuries can be classified in groups. One group deals with the simulation of illness, another with the occurrence itself and the application of chemical. thermic or mechanical methods.One sector concerns self-mutilation, which, from a psychiatrist's point of view, is interesting. At this time we are more concerned with the problems of proving it.In wartime and even during military service in peace-time soldiers inflict mutilating injuries on themselves. They are motivated by the notion that they will gain benefit from their action.Economic gain plays a role in the case of people who have taken out private accident insurance: self-mutilation to simulate the result of an accident.Our investigation into self-mutilation started with an analysis under the following aspects of 123 cases: age, sex, occupation, place of residence, place and time of deed, method employed (weapon used), localisation, single or multiple wound, direction of injury, position of fingers, nature of edges of wound.Whether or not an injury was suffered voluntarily or involuntarily can only be determined with the help of auxiliary facts. It must be clarified whether or not the information given by the injured person ties in with facts concerning the place where the injury was sustained, its position and its direction.The medico-legal expert should not interpret medical findings without relating them to the facts of the case. Indeed, he should start by examining the claimant's account of the accident.To some extent it almost requires the work of a general staff to compare the findings of a careful medical investigation with the injuries themselves.If the injury was inflicted by a certain tool information must be available regarding, for example, the accident with the saw together with an assessment of the wounds sustained (utilization of clinical material). Sometimes tests on corpses need to be carried out because these can provide information on mechanical and physical problems. When the direction of the wound is being clarified together with an appraisal of any traces found electron scanning and microscopic tests should also be incorporated into the examination in addition to medical and X-ray tests.At the slightest suspicion that a wound might have been self-inflicted appropriate tests should be carried out immediately. Conclusions should only be drawn by someone who has made an intensive study of this special field which is of such great forensic interest.

     

Emotional but not physical maltreatment is independently related to psychopathology in subjects with various degrees of social anxiety: a web-based Internet survey

ABSTRACT: BACKGROUND: Previous studies reported that social phobia is associated with a history of child maltreatment. However, most of these studies focused on physical and sexual maltreatment whilst little is known about the specific impact of emotional abuse and neglect on social anxiety. We examined the association between emotional maltreatment, including parental emotional maltreatment as well as emotional peer victimization, and social anxiety symptoms in subjects with various degrees of social anxiety. METHODS: The study was conducted as a web-based Internet survey of participants (N = 995) who had social anxiety symptoms falling within the high range, and including many respondents who had scores in the clinical range. The assessment included measures of child maltreatment, emotional peer victimization, social anxiety symptoms and general psychopathology. RESULTS: Regression and mediation analyses revealed that parental emotional maltreatment and emotional peer victimization were independently related to social anxiety and mediated the impact of physical and sexual maltreatment. Subjects with a history of childhood emotional maltreatment showed higher rates of psychopathology than subjects with a history of physical maltreatment. CONCLUSIONS: Although our findings are limited by the use of an Internet survey and retrospective self-report measures, data indicated that social anxiety symptoms are mainly predicted by emotional rather than physical or sexual types of victimization.     

Spezifische Dichte und Wassergehalt von Serum

Specific density and water content were measured in 1,044 specimens of serum obtained from alcoholized persons. The density was determined at room temperature under similar conditions to those used for the determination of blood alcohol levels. The density used in forensic medicine for calculation of the blood alcohol level is 1.03 g/ml, and the purpose of the study was to find whether this was adequate. The mean values recorded were 1.0252 g/ml with a standard deviation of 0.0023 g/ml for density and 90.55% with a standard deviation of 0.53% for water content. Only in 2% of all cases was the specific density slightly higher than 1.03 g/ml. This means that the value of 1.03 g/ml chosen in Germany for use in calculation of blood alcohol levels from alcohol levels in serum is high enough for nobody to be disadvantaged by this.     

Chloroformvergiftung eines jugendlichen Drogenkonsumenten

A young drug consumer died after sniffing and drinking chloroform. The method to determine chloroform in body fluids and tissues is described. The influence of the oral and pulmonary absorption in the view to cause of death is discussed.     

Studien zur Abklärung der primär krankhaften Veränderungen der unteren Extremitäten

Zusammenfassung Der Gehalt an Calcium, Magnesium, Kalium und Natrium in den Wandungen der V.femoralis, V.saphena und V.brachialis wurde mittels atomarer Absorption bestimmt. Für Calcium zeigen sich mit steigendem Alter deutliche Unterschiede unter den Venen. In der V.femoralis ist neben dem besonders hohen Calciumanstieg eine zunehmend inhomogene Verteilung im höheren Lebensalter zu finden.Mit finanzieller Unterstützung des Ministers für Wissenschaft und Forschung des Landes Nordrhein-Westfalen. Arbeitsprogramm Prof. Dotzauer: Grundlagenforschung auf dem Gebiet der Unterschenkelgefäße.     

Gaschromatographisches Verfahren zur Bestimmung des Kohlenmonoxidgehaltes im Blut

Zusammenfassung Es wird ein Verfahren zur Kohlenmonoxidbestimmung im Blut angegeben, das besonders für forensische Zwecke bei faulem oder stark denaturiertem Blut, aber auch für arbeitsmedizinische Probleme geeignet ist. Der gaschromatographische Nachweis des Kohlenmonoxids ist eindeutig. Der CO-Hb-Gehalt des Blutes errechnet sich aus der Eisenkonzentration der Probe und der festgestellten Kohlenmonoxidmenge.Die gegenüber spektralphotometrischen Untersuchungen längere Arbeitszeit wird durch die höhere Sicherheit und Beweisfähigkeit der Methode, insbesondere im Bereich geringer Konzentrationen, aufgewogen. An Brandleichen erhobene Befunde dürfen nur unter Berücksichtigung der Vorgeschichte interpretiert werden.     

A within-patient comparison between superovulation with intra-uterine artificial insemination using husband's washed spermatozoa and gamete intrafallopian transfer in unexplained infertility

The purpose of this study was to evaluate the success of gamete intrafallopian transfer (GIFT) and superovulation with intra-uterine artificial insemination (S-IUI) in couples with long-term unexplained infertility. Thirty-nine couples were offered three attempts at each treatment. Sixty-three IUI cycles were completed with a pregnancy rate of 1.5% per cycle. Forty-nine GIFT procedures were carried out with a pregnancy rate of 26.5% per cycle. The cumulative conception rate after three cycles of GIFT was 0.56. GIFT appears to offer a far greater chance of pregnancy than S-IUI in unexplained infertility.     

A randomized comparative study of purified follicle stimulating hormone and human menopausal gonadotropin after pituitary desensitization with Buserelin for superovulation and in vitro fertilization

Twenty patients entered a randomized, crossover study of purified follicle-stimulating hormone (pure-FSH) or human menopausal gonadotropin (hMG) superovulation, 2 ampules per day after pituitary desensitization with the luteinizing hormone-releasing hormone (LH-RH) analogue Buserelin (D-Ser tBu6 LH-RH 1-9 ethylamide) nasal spray. There were no cycles cancelled. Six patients conceived (five on pure-FSH, one on hMG). There were 24.2 +/- 2.5 (mean +/- standard error of the mean [SEM]) ampules of pure-FSH and 24.3 +/- 3.6 ampules of hMG stimulation required. There were similar numbers of preoperation follicles: 6.9 +/- 1.0 on hMG and 6.6 +/- 1.1 on pure-FSH, of oocytes collected; 8.5 +/- 1.4 on hMG and 5.8 +/- 1.4 on pure-FSH, and of pre-embryos achieved; 5.1 +/- 0.9 on hMG and 3.4 +/- 1.0 on pure-FSH; on either treatment. The fertilization rate on hMG was 60% and on pure-FSH was 55%. Pre-embryo transfer rates were 3.2 +/- 0.3 in the hMG group and 2.7 +/- 0.4 in the pure-FSH group. There were no differences in serum FSH, LH, estradiol, or progesterone levels between the hMG and pure-FSH groups. Mean +/- SEM luteal phase length was 10.6 +/- 0.4 days in the nonpregnant cycles.