Mongolian Spots - A challenging clinical sign.

Mongolian Spots (MS) are the most common birthmarks in newborn children. The condition presents as greenish-bluish to greyish macules, particularly in the lumbosacral area. The incidents of MS can vary in different ethnic groups and normally fade in early childhood. MS can be misinterpreted as hematomas because of the color and the predilection site. This paper discusses the case of a two-month old female admitted to hospital under suspicion of child abuse. The clinical forensic examination of the infant and her two older sisters found the children were in good health and did not show signs of abuse, despite the infant presenting with multiple and extensive greyish-blue macules. Thirteen months later, a welfare officer requested another forensic examination on the now 15-month-old child after noticing greyish-blue macules. Following a second examination, no evidence of abuse was found. This case illustrates the issue of MS as a differential diagnosis of hematomas.

The adulterated XANAX pill: a fatal intoxication with etizolam and caffeine.

A 49-year old man was found dead at home next to a glass containing a dried, white, crystalline substance and near a bag containing pills with the imprint XANAX, the trade name of alprazolam. A comprehensive screening of material collected during the autopsy revealed the presence of etizolam and caffeine in lethal concentrations (0.77 µg/mL and 190 µg/mL) but no trace of alprazolam. Benzodiazepine analogue etizolam is rarely prescribed in Germany, and as a result there are not many reports about fatal cases. It has anxiolytic, hypnotic, sedative and muscle-relaxant properties and is used for the short-term treatment of anxiety and panic attacks. The purine alkaloid caffeine, conversely, is the most widely used central nervous system stimulant. The following report outlines potentially the first reported case of a lethal combination of the downer etizolam and the upper caffeine in medical literature.

Distinction between forensic evidence and dermatological findings.

The external examination after death requires knowledge in forensics/pathology, dermatology, as well as associated diseases and age-related alterations of the skin. This article highlights some findings with forensic evidence versus dermatological findings. The lectures in forensic medicine should be structured interdisciplinarily, especially to dermatology, internal medicine, surgery, pathology, and toxicology in order to train the overlapping skills required for external and internal postmortem examinations.

Effect of different cytokines on mammaglobin and maspin gene expression in normal leukocytes: possible relevance to the assays for the detection of micrometastatic breast cancer.

In cancer patients, the ability to detect disseminated tumour cells in peripheral blood or bone marrow could improve prognosis and consent both early detection of metastatic disease and monitoring of the efficacy of systemic therapy. These objectives remain elusive mainly due to the lack of specific genetic markers for solid tumours. The use of surrogate tissue-specific markers can reduce the specificity of the assays and give rise to a clinically unacceptable false-positive rate. Mammaglobin (MAM) and maspin are two putative breast tissue-specific markers frequently used for detection of occult tumour cells in the peripheral blood, bone marrow and lymph nodes of breast cancer patients. In this study, it was evaluated whether MAM and maspin gene expression may be induced in the normal blood and bone marrow cells exposed to a panel of cytokines, including chemotactic factors (C5a, interleukin (IL)-8), LPS, proinflammatory cytokines (TNF-alpha, IL-1beta) and growth factors (IL-3, granulocyte-macrophage colony-stimulating factor, granulocyte colony-stimulating factor). The experimental data show that all cytokines included in the panel, except for IL-8, were able to induce maspin expression; on the contrary, MAM gene was never induced. These results suggest that MAM is more specific than maspin and that the possible interference of cytokines should be taken into account in interpreting molecular assays for detection of isolated tumour cells.

[Acceptance of silicone testicular prostheses in long-term follow-up]. / Akzeptanz von Silikonhodenprothesen im Langzeitverlauf.

The loss of a testicle is a psychological trauma, in particular for young men. The cosmetic defect can be corrected by implantation of a silicone testicular prosthesis (STP). The recurring discussion regarding the problems of silicone implants mainly concerns breast implants. STPs are made of equivalent material. Since we have been using STPs for 20 years, we wanted to research the opinion of our patients regarding these issues. Between 1978 and 1998, 51 STPs were implanted--37 times by groin incision and 14 times by scrotal incision--in 51 patients. The average age of the patients at the time of the operation was 23.3 years (14.3-55.4). Three implants had to be removed early. A questionnaire was distributed to all patients with STPs; 39 of the questionnaires were returned completed. The results--10.1 years postoperative--showed no serious late complications, an acceptance rate of 97% by the patients and about 50% by their female partners. Therefore, we will continue to offer the option for implantation of STP to our patients.

Limb joint surface areas and their ratios in Malagasy lemurs and other mammals.

Surface areas of humeral and femoral heads scale largely as a function of body size. However, differences in the relative sizes of these articular surfaces are correlated with differential joint mobility and force transmission through fore- and hindlimbs. They can therefore assist interpretation of the positional behavior of extinct species. In this paper, we document variation in ratios of humeral head surface area to femoral head surface area among extant primates and other mammals. We then examine a group of extinct primates: the subfossil lemurs of Madagascar. Many Malagasy lemurs, including some giant extinct species with very long forelimbs and short hindlimbs, have relatively small humeral heads and large femoral heads. We explore the adaptive implications of this pattern.

Size, space, and adaptation in some subfossil lemurs from Madagascar.

We examine several explanations for the geographic pattern of body size variation exhibited by the subfossil lemur Archaeolemur. Part and partial correlation analysis and multiple regression analysis are applied in a stepwise, hierarchical fashion to help to determine variable interdependencies. Variance in site means for body size is best explained by the richness of the plant community and by several correlated climatic variables (bioclimatic zone and mean annual rainfall). Body size differentiation in Archaeolemur roughly mirrors patterns observed among many other Malagasy lemur species and subspecies groups. This consistency alone suggests that common ecological factors have strongly affected size differentiation in lemurs, most probably (as suggested by our correlation analyses) by uniformly influencing the productivity of their niches. Smaller individuals tend to inhabit arid regions, and larger individuals tend to inhabit wetter regions. The interplay between selective differentiation and allopatric speciation appears to have yielded the concordant pattern of size variation observed in Malagasy lemurs.