RESUMO
In 215 cases of intracranial tumors with subsequent histological identification, computerized transaxial tomography (CTT), and cerebral serial scintigraphy (CSS) with [99mTc] pertechnetate were carried out to compare the efficiency of each method in detecting and classifying such tumors. With a tumor detection rate of 99%, CTT turned out to be superior to CSS (91%). On the other hand, CSS findings enhanced the CTT rate of correctly identified tumor types in meningiomas from 85 to 92% and in high-grade gliomas from 82 to 89%. In metastases, low-grade gliomas, and various other tumors, CSS supported CTT by confirming a number of these tumor types. Therefore, the most important use of CSS in intracranial tumors today is its role as a supplement to CTT in order to establish and confirm type-specific diagnoses.
Assuntos
Neoplasias Encefálicas/diagnóstico , Glioma/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Cintilografia/métodos , Tomografia Computadorizada por Raios X , Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Metástase Neoplásica , TecnécioRESUMO
OBJECTIVES: To investigate the influence of season and outdoor daylight exposure on serum levels of 25-hydroxyvitamin D (25OHD), intact parathyroid hormone (PTH), ionized calcium, and femoral neck bone mineral density (BMD). DESIGN: A 12-month, longitudinal, prospective study on a consecutively selected sample of healthy independent older people. SETTING: Men and women living in their own homes in the inner city of Stockholm (latitude 59.2 degrees N). PARTICIPANTS: Sixty-four healthy men (n = 13) and women (n = 51), age 79 to 96 (mean age 83.7) were requested to spend at least 3 hours per week outdoors during April through September. Fifteen of these, who failed to comply with the required time outdoors, constituted a separate group. Subjects with serious diseases and subjects with medication that could interfere with vitamin D metabolism or bone mineralization were excluded from the study. MEASUREMENTS: Daily dietary intakes of calcium and vitamin D were recorded on the basis of the subjects' recall. The participants kept a diary recording the time spent in sunlight and the area of skin exposed. Fasting blood samples were collected and analyzed on four occasions for 25OHD, intact PTH, and ionized calcium. BMD was determined at 6-month intervals in the femoral neck, using dual energy x-ray absorptiometry. RESULTS: At study start in the spring, 6% of the subjects had 25OHD levels below 10 ng/ml and 78% had levels below 31 ng/ml. Forty-seven percent had intact PTH levels above the upper limit of the reference range (8-51 ng/L). Seasonal variations in the serum levels of 25OHD (P <.001), intact PTH (P <.001) and ionized calcium (P <.001) were observed only in the group with > or =3 hours of weekly outdoor daylight exposure. The 25OHD levels in autumn were positively correlated with the number of hours spent outdoors during the preceding summer (r = 0.63, P <.001). In the whole group and in the group with weekly outdoor exposure of > or =3 hours, there were no significant changes detectable in mean values of femoral neck BMD during the study year. Femoral neck BMD, expressed as Z-score, was significantly and positively correlated with serum 25OHD (r = 0.38, P =.003 after summer; r = 0.37, P =.003 after winter). CONCLUSION: The seasonal changes in serum levels of 25OHD, PTH, and ionized calcium and the positive correlation between femoral neck BMD and 25OHD indicate that regular outdoor daylight exposure during the summer could enhance calcium homeostasis and possibly bone health, even among very old people living at northerly latitudes.
Assuntos
Densidade Óssea , Hormônio Paratireóideo/sangue , Estações do Ano , Luz Solar , Vitamina D/análogos & derivados , Vitamina D/sangue , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Feminino , Colo do Fêmur , Humanos , Masculino , Estudos Prospectivos , Análise de Regressão , Estatísticas não Paramétricas , Suécia , Fatores de TempoRESUMO
OBJECTIVE: To determine serum 25-hydroxyvitamin D3 [25(OH)D3] and its 1-hydroxylated metabolite [1,25(OH)2D3] and relate them to anthropometric data, life-style habits, blood pressure and selected biochemical analytes. DESIGN: Random population samples of men and women. SETTING: Göteborg, Sweden, population size 450,000 inhabitants. The study was performed within the framework of the WHO MONICA Project. SUBJECTS: 2000 randomly selected subjects were invited to the main MONICA screening. Out of those 1421 (71%) participated. Fifty individuals in each of four age-groups, 25-64 years, were selected at random for the present analyses (184 men and 198 women). RESULTS: The concentration of 25(OH)D3 was similar in both sexes whereas 1,25(OH)2D3 concentration was higher in women than in men (P = 0.01). 25(OH)D3 correlated positively to sun exposure, physical activity and negatively to intact parathyroid hormone (PTH) in both sexes, and also negatively to blood pressure in men. The remaining significant relationship for 25(OH)D3, when age and sun exposure were taken into account in multivariate analyses, was a negative correlation to intact PTH in both sexes. 1,25(OH)2D3 correlated positively to intact PTH in both men and women, negatively to height in men, positively to fibrinogen in men and positively to psychological stress and osteocalcin in women. When all variables were included in multivariate analyses 1,25(OH)2D3 concentration correlated negatively to age and positively to intact PTH and osteocalcin in both sexes together. CONCLUSIONS: Sunlight was the only external factor that influenced 25(OH)D3 concentration whereas 1,25(OH)2D3 was unaffected by sun exposure. 1,25(OH)2D3 was not related to environmental or life style factors but declined by age and correlated positively to intact PTH and osteocalcin. SPONSORSHIP: Grants from the Swedish Medical Research Council and the Swedish Heart and Lung Foundation.
Assuntos
Calcifediol/sangue , Esteroide Hidroxilases/sangue , Luz Solar , Adulto , Fatores Etários , Pressão Sanguínea , Estatura , Colestanotriol 26-Mono-Oxigenase , Feminino , Fibrinogênio/análise , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inquéritos Nutricionais , Osteocalcina/sangue , Hormônio Paratireóideo/sangue , SuéciaRESUMO
Pontocerebellar hypoplasia (PCH) is a very rare congenital (autosomal recessive) condition with fetal onset. Only a few cases have been published on the basis of both clinical data (symptoms/neuroradiological imaging) and autopsy results. This paper reports on such a case involving a 1.5-year-old male infant. The child suffered from severe psychomotor delay, extrapyramidal dyskinesia and epileptic seizures, but did not exhibit signs of spinal muscular atrophy as related to PCH type 1. Magnetic resonance imaging (MRI) at the age of 6 months demonstrated olivo-pontine and bilateral cerebellar hypoplasia. The boy was unexpectedly found dead. Autopsy disclosed a severe aspiration of gastric contents as the final cause of death. The neuropathological examination confirmed PCH type 2 (according to Barth [Brain Dev., 15 (1993) 411-422]) with marked microcephaly and olivopontocerebellar hypoplasia. Histologically, decreased density of olivo-pontine neurons, reduction of granular and Purkinje's cell layers of the cerebellum, slight astroglial proliferation and fragmented appearance of the dentate nuclei were observed. The immunohistochemical expression pattern was determined using antibodies against glial fibrillary acidic protein, synaptophysin and neurofilament protein. Summarizing, typical features of PCH type 2 were present and proved by clinical course, MRI and autopsy. Despite severe symptoms due to a natural disease this rare neurogenetic entity can become of forensic interest, when sudden unexpected death occurs.
Assuntos
Autopsia/métodos , Morte Súbita/etiologia , Atrofias Olivopontocerebelares/congênito , Atrofias Olivopontocerebelares/diagnóstico , Causas de Morte , Criança , Deficiências do Desenvolvimento/etiologia , Discinesias , Epilepsia/etiologia , Evolução Fatal , Humanos , Imuno-Histoquímica , Masculino , Atrofias Olivopontocerebelares/classificação , Atrofias Olivopontocerebelares/genéticaRESUMO
Proinflammatory cytokines play an important role in the mediation of inflammation and trauma. They could be useful for the determination of vitality and wound age. In the present study, 144 human skin wounds due to sharp force were investigated. The material was collected during operations (N=96) and postmortem examinations (N=48). The wound age varied from several seconds or minutes to 9 days. Control skin was available in each individual. The tissue specimens were homogenized and extracted in a solution of PBS and protease inhibitors. Interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-alpha) were measured by quantitative ELISA analysis. Statistical evaluation was performed by the t-test using the quotients of levels (wound sample/control skin). In surgical specimens the cytokine levels revealed a clear tendency to increase with wound age. IL-1beta in early skin wounds (=30 min) and TNF-alpha after a wound age of 1-2 h demonstrated statistically significant changes in comparison with control skin (P<0.05). In autopsy samples with severe traumatization excessive elevation of cytokine levels was observed: IL-1beta, IL-6 and TNF-alpha showed significant increases (P<0.001-0.05) in stab and incised wounds with very short survival times of less than 5 min, but not in possibly supravital injuries. Elevated IL-6 levels persisted in older wounds (>24 h, P<0.05). The quantitative analysis of proinflammatory cytokines in wound extracts can contribute to the determination of vitality and wound age, in particular in the very early post-traumatic interval (classic stab wounds).
Assuntos
Autopsia/métodos , Ensaio de Imunoadsorção Enzimática/métodos , Interleucina-1/análise , Interleucina-6/análise , Mudanças Depois da Morte , Pele/lesões , Fator de Necrose Tumoral alfa/análise , Ferimentos Penetrantes/patologia , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Cicatrização/imunologia , Ferimentos Penetrantes/classificação , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/imunologiaRESUMO
Fibronectin, collagen type III, laminin, and cytokeratin 5 were visualized in normal skin and in skin showing early or advanced signs of autolytic decomposition to prove whether the immunohistochemical analysis of these antigens can provide useful information for an age-estimation of skin wounds obtained from putrified corpses. In cases with early signs of decomposition (visible course of veins, greenish discoloration) and without microscopic alterations like relaxation of the epidermal cell layers or destruction of the blood vessel structures, the staining pattern was identical to that found in normal, non-putrefied skin. In skin already showing microscopic alteration of the tissue structure, fibronectin and collagen type III could not be localized unambiguously. The distribution of laminin and cytokeratin 5, however, was well preserved. In advanced putrefied skin no reliable staining results could be obtained for fibronectin, collagen type III, and laminin. Even though cytokeratin 5 was still detectable in remnants of decomposition-resistant skin appendages, no information useful for an age-estimation of skin wounds can be obtained due to the autolytic detachment of the epidermal layers.
Assuntos
Colágeno/análise , Queratinas/análise , Laminina/análise , Mudanças Depois da Morte , Pele/patologia , Humanos , Técnicas Imunoenzimáticas , Pele/lesões , Cicatrização/fisiologia , Ferimentos e Lesões/patologiaRESUMO
We monitored the immunohistochemically determined amount of surfactant-producing alveolar type II cells in human fetal lung using polyclonal antibodies against apoprotein B and C of human pulmonary surfactant. Lungs of 30 dead-born fetuses without lung affection aged between 15 and 38 weeks of gestation were evaluated and the surface density of surfactant-producing alveolar type II cells was determined by morphometry. In lungs of fetuses with a gestational age less than 22 weeks no relevant number of positively reacting cells could be found. Between the 22nd and 29th week a progressive increase with considerable inter-individual variability was observed. From the 30th week on the number of the type II pneumocytes appeared rather constant without further significant increase. We provide evidence that the immunohistochemical detection of surfactant-producing alveolar type II cells is useful for the determination of the age of unknown and especially fragmented fetuses: The lack of surfactant-producing alveolar type II cells in fetal lungs before the 22nd week allows a rather safe distinction between fetal lungs of higher age from those of lesser age. Between the 22nd and 29th week an age-dependent increase in the number of these cells occurs with wide inter-individual variability allowing only an approximate age determination. In particular, this may be an important piece of information in fragmented fetal corpses. Furthermore, the number of surfactant-producing alveolar type II cells provides additional information on pulmonary maturation and may thus be helpful in the estimation of a theoretical survival chance.
Assuntos
Idade Gestacional , Pulmão/embriologia , Surfactantes Pulmonares/análise , Apoproteínas/análise , Apoproteínas/imunologia , Feminino , Humanos , Imuno-Histoquímica , Pulmão/química , Pulmão/citologia , Gravidez , Surfactantes Pulmonares/biossíntese , Surfactantes Pulmonares/químicaRESUMO
Two lethal cases of penetration injury of the orbita are reported. The injuries were caused directly by the point of an umbrella (accident or homicide), leading to canalicular destruction of the frontal lobe of the cerebrum. The mechanism of injury with cerebral involvement was not determinable except by autopsy, and the importance of a thorough clinical examination is therefore emphasized.
Assuntos
Ferimentos Oculares Penetrantes/patologia , Lobo Frontal/lesões , Fraturas Orbitárias/patologia , Ferimentos Perfurantes/patologia , Adulto , Hemorragia Cerebral/patologia , Evolução Fatal , Lobo Frontal/patologia , Humanos , Masculino , Órbita/patologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The transplantation of the limbus is based on the theory that limbal stem cells are necessary for epithelialisation and maintenance of a clear cornea. We used a genetic analysis procedure to demonstrate the survival of transplanted limbus stem cells. PATIENT AND METHODS: A lamellary corneal graft and limbus transplantation from donor material was carried out on a patient with severe alkali burns and destroyed Bowmann's membrane to prepare the cornea for perforating keratoplasty. Subsequently, perforating corneal graft was carried out and the epithelium and endothelium of the removed cornea were analysed with a gene analytical procedure. For the cellular typing we used the SGM kit, well known in forensic analysis, that allows simultaneous detection of alleles at 11 loci. The genetic analysis was performed using an ABI PRISM 310 Genetic Analyser (Perkin Elmer Applied Biosystems) after DNA amplification by the polymerase chain reaction. RESULTS: The cornea-limbus transplant was integrated without vascularisation from the limbus under treatment with cyclosporin A. The epithelium cells of the corneal tissue gained by keratoplasty had the same genetic pattern as the primary donor in all loci, but no congruence with the recipient (except for the amelogenin marker because both the donor and the recipient were males). Therefore the epithelium cells must have originated from the transplanted stem cells of the donor. CONCLUSIONS: The identical genetic pattern found for the donor and the epithelium of the corneal-limbal transplant demonstrate the survival of the transplanted stem cells in a patient with adequate cytostatic therapy.
Assuntos
Queimaduras Químicas/cirurgia , Lesões da Córnea , Transplante de Córnea , Epitélio Corneano/citologia , Queimaduras Oculares/induzido quimicamente , Limbo da Córnea/citologia , Transplante de Células-Tronco , Adulto , Queimaduras Oculares/cirurgia , Teste de Histocompatibilidade , Humanos , MasculinoRESUMO
The clinical and pathological-anatomical features of lipomas of the hypopharynx, based on a review of 23 cases presented in the literature and exemplified by a new case, are discussed. The tumour may be solitary or multiple and appears mostly in men over the age of forty. Although it may reach a considerable size, it may be asymptomatic, until it appears in the mouth or suffocation occurs. Recurrences are rare but metachronous multiple lipomas may appear. Long-term follow-up is therefore recommended. The difficulties of differential diagnosis between lipomas and well-differentiated liposarcomas are discussed.
Assuntos
Hipofaringe , Lipoma/diagnóstico , Neoplasias Faríngeas/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Lipoma/patologia , Neoplasias Faríngeas/patologiaRESUMO
We report 23 cases of considerable differences of the results of breath alcohol analyses and the corresponding blood alcohol analyses observed by seven Institutes of Forensic Medicine in Germany and Austria. The usefulness of breath alcohol analysis on forensic casework at the courts will have to be evaluated on the bases of the possibility of such grave deviations.
Assuntos
Consumo de Bebidas Alcoólicas/sangue , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Intoxicação Alcoólica/sangue , Intoxicação Alcoólica/diagnóstico , Testes Respiratórios/instrumentação , Etanol/farmacocinética , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos TestesRESUMO
In Germany firearms camouflaged as items of daily use are forbidden. While reports on ball-point pen-guns have repeatedly been published in literature, the use of a walking-stick gun is a rarity. The report deals with the suicide of a 31-year-old schizophrenic man who inflicted a shotgun injury to his head with typical morphological characteristics. The weapon used was a normal-looking walking stick with a barrel, cal. .410. Under forensic and criminological aspects the significance of a walking-stick gun is comparable to that of ball-point pen-guns. Both weapons can be carried and used inconspicuously, but from a walking-stick gun also ammunition of larger calibres with a higher potential of injury can be fired.
Assuntos
Lesões Encefálicas/patologia , Armas de Fogo , Suicídio/legislação & jurisprudência , Ferimentos por Arma de Fogo/patologia , Adulto , Lesões Encefálicas/psicologia , Humanos , Masculino , Psicopatologia , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicologia , Suicídio/psicologia , Ferimentos por Arma de Fogo/psicologiaRESUMO
Suicidal gunshot wounds from a livestock stunner with infliction of two shots against the head are extremely rare events. A case with these characteristics is presented and the corresponding literature is reviewed. A 61-year-old butcher was found dead with two entry wounds of the forehead on the right side and in the centre being typical for captive bolt pistols (symmetrically localized powder burns). The issues of the sequence of shots and the capacity of action are discussed on the basis of morphological findings and pathophysiological considerations. A literature review revealed only 4 case reports with double gunshot wounds of the skull caused by "humane killers" (Tovo 1956, Wolff and Laufer 1965, Schiermeyer 1973, Pollak 1977).
Assuntos
Lesões Encefálicas/patologia , Armas de Fogo , Suicídio/legislação & jurisprudência , Ferimentos por Arma de Fogo/patologia , Encéfalo/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Suicidal deaths caused by pipe bombs are rare. An 18-year-old man was found dead in a forest by hikers. In immediate proximity to the body, a crater was located obviously induced by a detonation. The postmortem examination revealed severe damage of the head, upper-body and both arms and hands along with the extensive presence of soot and dirt. Particularly noticeable were numerous "entry wounds" and the presence of five bullet like pieces of metal in the body. The young man had a history of drug abuse and psychiatric problems. On the basis of autopsy findings, the conclusions of the police investigation and psychopathological considerations regarding the victim's case-history, discussion centers upon the differentiation between suicide by self-explosion, homicide by explosion or death as a consequence of numerous bullet wounds followed by an attempt to burn the body. Also considered is the possibility of paranoid psychosis induced by cannabis use as a cause of suicide.
Assuntos
Traumatismos por Explosões/patologia , Explosões/legislação & jurisprudência , Suicídio/legislação & jurisprudência , Adolescente , Autopsia/legislação & jurisprudência , Causas de Morte , Alemanha , Humanos , MasculinoRESUMO
UNLABELLED: Up to now reliable data were available on cases of lethal child neglect in the area of the Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period from 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 19 cases of lethal child neglect. Extrapolated to all institutes of legal medicine, this corresponds to 20 cases and thus 3.5 cases a year in the whole of West Germany in the period studied. There is to be added a dark-field which cannot be limited more precisely. However, the cases of fatal child neglect might have occurred much more seldom than fatal child abuse caused by use of physical violence. Slightly more than half the victims were younger than 1 year, the oldest one was 7 10/12 years old. Most frequently the children died of starvation and thirst. Mostly the mothers/nursing mothers killed the child alone or together with the victim's father/stepfather. In the majority of the cases there was not a close affection between parents and child. Nearly 30% female/male perpetrators suffered from chronic alcohol abuse. Only 15 (= 56%) of 27 female/male perpetrators were sentenced to imprisonment (period between 7 months on probation and 10 years). Mitigation circumstances existed for nearly half the persons sentenced to imprisonment. It is true that child neglect is a rarer crime, but the experts of legal medicine always have to indicate errors made during the external inspection of the corpse (among others failures to see indications of neglect).
Assuntos
Maus-Tratos Infantis/mortalidade , Causas de Morte , Criança , Maus-Tratos Infantis/legislação & jurisprudência , Pré-Escolar , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Lactente , MasculinoRESUMO
UNLABELLED: No reliable data are available on cases of lethal child abuse (by active force) in the area of Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 58 cases of lethal child abuse. Extrapolated to all institutes of legal medicine, this corresponds to 62 cases in all of West Germany in the period studied. An approximately equal number of unreported cases should be added to this figure. Including unreported cases, at least 20 cases of lethal child abuse occurred per year; thus only one in every two cases ever came to light. Almost two thirds of the victims were younger than one year old. At autopsy 59% exhibited signs of repeated abuse at autopsy. By far the most common cause of death was direct impact from a blunt object, usually to the head. Mostly, the male person to whom the victim relates most closely (father, stepfather, partner of the mother) has killed the child. Twenty-one of the 74 persons charged saw the charges against them dropped or were acquitted due to lack of evidence; 51 received sentences ranging from one year probation to life. In the remaining two cases the outcome of the trial was unknown. Signs of abuse were readily apparent at autopsy in almost all cases. The high number of unreported cases underscores the need to educate medical students and practicing physicians to be on the look-out for signs of abuse and argues for an increase in the rate of autopsy.
Assuntos
Síndrome da Criança Espancada/mortalidade , Maus-Tratos Infantis/legislação & jurisprudência , Violência/legislação & jurisprudência , Autopsia/legislação & jurisprudência , Causas de Morte , Criança , Maus-Tratos Infantis/mortalidade , Pré-Escolar , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Lactente , Masculino , Violência/estatística & dados numéricosAssuntos
Cardiomiopatias/patologia , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Cálcio/antagonistas & inibidores , Cardiomegalia/patologia , Cardiomiopatias/tratamento farmacológico , Feminino , Insuficiência Cardíaca/patologia , Humanos , Rim/patologia , Fígado/patologia , Masculino , Edema Pulmonar/patologia , Baço/patologiaRESUMO
Vitamin D3 is produced in the skin of animals and humans by the sun's ultraviolet rays (UVB region, 290-315 nm). The main metabolite 25-hydroxyvitamin-D3 has a seasonal variation, depending on the ultraviolet radiation. In the Antarctic preliminary investigations on penguins (Pygoscelis papua), female sea elephants (Mirounga leonina), and humans showed that there was an increase in plasma 25-hydroxyvitamin-D3 concentrations during UV-exposure in all three species. This metabolite can therefore be regarded as a molecular indicator of UV radiation. The possibility to use this compound in a long term monitoring program, for UV radiation, is under investigation.