Comparison of direct and indirect alcohol markers with PEth in blood and urine in alcohol dependent inpatients during detoxication.

The importance of direct and indirect alcohol markers to evaluate alcohol consumption in clinical and forensic settings is increasingly recognized. While some markers are used to prove abstinence from ethanol, other markers are suitable for detection of alcohol misuse. Phosphatidyl ethanol (PEth) is ranked among the latter. There is only little information about the correlation between PEth and other currently used markers (ethyl glucuronide, ethyl sulfate, carbohydrate deficient transferrin, gamma-glutamyl transpeptidase, and methanol) and about their decline during detoxification. To get more information, 18 alcohol-dependent patients in withdrawal therapy were monitored for these parameters in blood and urine for up to 19 days. There was no correlation between the different markers. PEth showed a rapid decrease at the beginning of the intervention, a slow decline after the first few days, and could still be detected after 19 days of abstinence from ethanol.

[Overcoming of radiation resistances]. / Strahlenresistenzen und ihre Überwindung.

Despite good achievements in prevention and control, cancer is still a leading cause of death worldwide. The development of resistances against conventional treatment modalities is one of the main causes of failure in the treatment of cancer. Radio- and chemotherapies fail frequently due to intrinsic or acquired resistances in apoptotic signalling pathways or alterations in DNA-repair processes. Targeted radiotherapies employing α-particle-emitting radionuclides and Auger-emitting electrons are a promising approach in cancer treatment to break radio- and chemoresistance by overcoming DNA-repair mechanisms and reversing deficient activation of apoptotic pathways in cancer cells.

Mycobacterium avium resists exposure to the acidic conditions of the stomach.

Organisms of the Mycobacterium avium complex are common pathogens in immunosuppressed patients such as individuals with AIDS. There is evidence that in AIDS patients, the main route for M. avium infection is the gastrointestinal tract. The stomach is a formidable barrier to pathogens and the ability to resist exposure to pH lower than 3 has been shown to be a virulence determinant of enteric pathogens. Incubation of three clinical isolates of M. avium under acidic pH revealed resistance of M. avium grown both to the exponential and stationary phase at pH 2.2 for 2 h. Inhibition of protein synthesis had no effect on the acid tolerance. When the duration of the incubation at pH 2.2 was extended to 24 h, bacteria grown to the stationary phase had a significantly greater tolerance to acid than exponential phase bacteria. M. avium incubated with acid in the presence of water was significantly more resistant to pH 2.2 than M. avium in the presence of buffer. Pre-adaptation in water prior to exposure to acidic conditions was also associated with increased resistance to pH 2.2. Isoosmolarity of Hank's balanced salt solution appears to be responsible for the impaired resistance to acid between 2 and 24 h of incubation. These findings indicate that M. avium is naturally tolerant to pH<3 and that pre-adaptation under conditions similar to the conditions where M. avium is found in the environment results in increased acid resistance.

Isolation of two subpopulations of Mycobacterium avium within human macrophages.

Mycobacterium avium is an intracellular pathogen that is associated with disseminated infection in acquired immunodeficiency syndrome (AIDS) patients. Human monocyte-derived macrophages were infected with M. avium strain 101 and a quinolone (Bay y 3118) was used at 8 micrograms ml-1, a concentration that kills growing bacteria but fails to eliminate static organisms. Infected monolayers were treated with Bay y 3118 for 4 days and viable bacteria obtained from the lysis of macrophages were used to infect other macrophages without passage in media. The procedure was repeated five times, after which seven different subpopulations that failed to grow within macrophages were identified. While the DNA fingerprinting confirmed that all came from the same strain, three protein profiles were observed. Static subpopulations were not killed by cytokine-stimulated macrophages, in contrast to the replicating subpopulation. Three of the static subpopulation strains were shown to be auxotrophic for glutamic acid or methionine. All seven non-duplicating subpopulation strains grew well in complete 7H10 agar. The importance of a static subpopulation of M. avium within macrophages is presently unknown. It is possible, however, that the non-growing bacteria would persist within macrophages.

Fatal poisoning with the antidepressive agent opipramol.

An ingestion of an unknown quantity ( < or = 3000 mg) of opipramol dihydrochloride in a suicide case is described. Quantitation of opipramol and its deshydroxyethyl metabolite was performed simultaneously after liquid-liquid extraction from alkalinized samples prior to HPLC analysis. Postmortem concentrations of opipramol and of the metabolite in body fluids and organs are given. The distribution pattern of opipramol in tissue was comparable to findings from animal studies. The results showed the high uptake of opipramol in parenchymal tissues resulting in a low blood concentration. A possibly low contribution of deshydroxyethyl opipramol to the antidepressive effect may be concluded as the concentration was considerably lower in brain compared to other organs.

Dissection of the anterior and middle cerebral artery with fatal ischemia following kicks to the head.

A 19-year-old male received kicks to his head in the course of a fight with other young people. On admission to hospital he became drowsy and developed a hemiparesis and a facial paralysis on the right. After 3-4 days of continuous improvement the patient suddenly fell unconscious again and died on the seventh day after the trauma due to an increase of the intracranial pressure. Neuropathologic examination revealed an extensive dissection of the wall of the left anterior and middle cerebral artery. The age of the recurring infarction in the dependent areas of blood supply corresponded to the biphasic clinical course.

Morphometrical analysis of retinal hemorrhages in the shaken baby syndrome.

A morphometrical analysis of retinal hemorrhages was performed in cases of physical child abuse including the shaken baby syndrome and in controls (severe head injury, intravital brain death, non-traumatic intracranial hemorrhage, SIDS including cardiopulmonary resuscitation). The extent of the retinal hemorrhages was significantly different between both groups. In all cases of physical child abuse, massive retinal hemorrhages in at least one eye could be found ranging between a maximum value of 19.2 and 73.2% of the entire retinal area. In contrast, only two cases of the control group (severe head injury with skull fractures and intracranial bleeding following traffic accident or fall) showed slight hemorrhages of 3.33 or 1.18% of the retinal area but only in one eye. Therefore, the results provide evidence that massive intraretinal hemorrhages indicate violent shaking -- in particular in association with other signs of physical child abuse.

Influencing factors on the injury severity of restrained front seat occupants in car-to-car head-on collisions.

The results of 319 cases of belt-restrained front seat car occupants (234 drivers and 85 passengers) from 241 vehicles in car-to-car head-on collisions were examined. Ninety-five occupants were uninjured, 195 sustained a total injury severity of Maximum Abbreviated Injury Score (MAIS) 1-3 and 29, MAIS 4-6. There were 27 fatalities, and the main causes of death were polytrauma and hemorrhage. The main factors influencing occupant injury severity were: the energy equivalent speed (EES); the change of velocity (delta upsilon); the maximum deformation depth; and the collision angle. With an EES > 50 km/h fatal injuries can be expected, and above 60 km/h no occupant remained uninjured. The results of a multivariate analysis were: EES influenced the injury severity at all body locations except the spinal cord; occupant position effected only head injury severity, with drivers being more severely injured; occupant age influenced the injury severity at the thorax, abdomen, and extremities and MAIS as well. Age was a further factor influencing injury severity, e.g. with an EES of 50 km/h the probability of being fatally injured was 30%-45% higher for occupants over 59 years than those under 20.

Injury severity of restrained front seat occupants in car-to-car side impacts.

The influence of a number of factors, including age and particularly seating position, on the injury severity of restrained occupants was examined for 41 front-seat occupants seated adjacent to the impact (near side) and 38 sitting opposite the impacted side (far side) in car-to-car side collisions (center of impact: front door and B-pillar). Above an energy equivalent speed of 40 km/h all near-side occupants and about half of the far-side occupants sustained severe injuries. A logistic regression analysis showed that within range of 30-60 km/h (delta v 20-60 km/h) the probability of severe injuries increased dramatically from approximately 20% to more than 90%; in these cases, far-side occupants had the same injury probability as near-side occupants only when the speed was 10 km/h higher. The main cause of death for 27 occupants seated on both sides was polytrauma, this was accompanied in two-thirds of the cases by serious head injuries. The second most frequent cause of death was head injury.

[Blindness caused by an airbag in a minor accident]. / Erblindung durch Airbag bei Bagatellunfall.

PURPOSE: Installation of airbags has reduced the rate of fatal injuries in severe automobile accidents. We report, however, severe ocular injuries in a minor accident as the result of an airbag. CASE REPORT: A front passenger suffered a blunt ocular trauma of her right eye during a collision. The approaching speed was about 31 km/h. The maximum change of velocity in direction of the impact was 19 km/h. Color traces were found on the upper rim of the airbag, apparently from the patient's eye shadow. RESULTS: In the emergency room, visual acuity was reduced to light perception. There was endothelial contusion, traumatic mydriasis, and lens subluxation. A sclopetarian retinopathy developed with a chorioretinal scar. Eight months after the accident visual acuity remained at light projection only. CONCLUSIONS: The eye injuries had very probably been caused by the deploying airbag. Improvements are a better geometry of deployment (e.g., tethered airbags), release at higher impacts only, and "intelligent systems" with additional sensors to avoid potentially hazardous airbag inflation in minor accidents.

[Alcohol concentration in the paranasal sinus fluid in drowning]. / Alkoholkonzentration in der Nebenhöhlenflüssigkeit beim Ertrinken.

In 20 of 31 drowned persons we found 0.3 to 3.5 ml fluid in the maxillary and sphenoid sinus. In 18 cases the fluid could be recognised roentgenologically. In 9 cases blood and fluid in the paranasal sinus were free of ethanol. In 6 of 11 cases the concentration of ethanol in blood and fluid of the paranasal sinus corresponded very well, in the other cases the variation ranged from -51.8 to 147%. Ethanol in both blood and fluid of the paranasal sinus seems to confirm the diagnosis "drowning".

[Value of blood alcohol concentration in the assessment of legal responsibility]. / Zum Stellenwert der Blutalkoholkonzentration bei der Beurteilung der Schuldfähigkeit.

We analysed the files of an Amts- and Landgericht from the years 1982/83. Among about 4000 cases we found 148 condemnations, in which sections 20/21 StGB were discussed. Each offence included 207 variables. 63 cases were left to be evaluated: 10 cases with section 20, 43 cases with section 21, 10 cases with refused section 21. Most of the delinquents lived alone, drank much alcohol very often, were socially unadaptable, previously convicted, unemployed and little qualified. Due to lack of findings of facts and diverging testimonies of psychic findings we found no significant correlation between level of blood alcohol concentration, psychic findings and degree of decreased condemnability.

[Death caused by hurling a truck plate spring into the interior of an automobile]. / Tod nach Schleudern einer Lkw-Blattfeder ins Innere eines Pkw.

On the highway, a part of a truck's plate-spring of uncertain origin hurls into the interior of a car. Despite of resuscitation efforts the driver dies on the way to the hospital. With at first missing extensive exterior injuries, death due to pre-existing cardiac rhythm disturbances was assumed. Legal autopsy presented contusion of the heart as cause of death. By the kind of sternum fracture, cardiac contusions could be clearly separated from resuscitation injuries.

[Capacity to act after stab and cutting injury]. / Zur Handlungsfähigkeit nach Stich- und Schnittverletzung.

Among 31 cases of death by stab or cut from the years 1989 to 1991 a common injury pattern cases was brought out and related to surviving-time and the capacity to act. The results revealed a short surviving-time if a great blood loss can occur in a short time. There was no correlation between the volume of blood loss and the capacity to act or the lungs weight. From these cases, three cases are reported. First, a single throatcut with cut of the trachea and a surviving-time of 30 minutes. Second, one case of a single heart stab in which the victim could run about 100 meters, and third, one case of an isolated cut of the A. pericardiaca and an estimated surviving-time of 4-12 hours.

[Errors in treatment of soft tissue phlegmon : expert assessment and forensic evaluation]. / Fehler bei der Behandlung von Weichteilphlegmonen: Begutachtung und rechtliche Würdigung.

In ten cases of soft part phlegmons resulting in death (8) and amputation (2) respectively, various types of medical malpractice were evident. The diagnosis was missed, or the disease was correctly diagnosed but underestimated. Typical therapeutic mistakes were the omission of bacteriological investigations and of the proper antibiotical therapy, a delayed hospital admission, or a delayed or insufficient surgical intervention. These errors however could never be proved to have caused the unfavorable outcome in view of the doubtful prognosis of soft part phlegmons even under proper treatment. Thus, evident malpractice never resulted in a condemnation for bodily injury or involuntary manslaughter.

The influence of age on injury severity of restrained front seat occupants in head-on collisions.

This excerpt is part of a large-scale retrospective study on the interrelationship between accident severity and injury severity. A multivariate analysis of 319 cases of restrained front seat occupants involved in car-to-car head-on collisions showed the significant influence of the energy equivalent speed (EES) and age of the occupants on the number of rib fractures and sternum fractures. Three hundred occupants sustained no rib fractures, nine occupants one to 16 rib fractures, and ten occupants 17 to 32 rib fractures. In these three groups the EES increased from 35 km/h (no rib fractures) to 55 km/h (one to 16 rib fractures) and to then to 67 km/h (17 to 32 rib fractures). The average age in these groups was 34, 55 and 57 years respectively. Twenty-four occupants sustained sternum fractures. The average values of the EES and the average age were: in the group with sternum fractures: 56 km/h; 50 years old; in the group without sternum fractures: 35 km/h; 34 years old. The probability of sustaining fatal injuries in a head-on collision depended on the EES as well as the age of the occupant. At an EES of 60 km/h the probability of fatal injuries was 0.05% in the group < 30 years and 35% in the group > 59 years. Fifty-eight per cent of the occupants with sternal fractures had rib fractures as well; 46% of the occupants with rib fractures also had sternal fractures. The results were compared to the results of 185 post-mortem simulations of head-on collisions from the year 1973 to 1978. In post-mortem simulations the number of rib fractures and sternum fractures was influenced by vehicle decelerations and the age of the test subjects. The number of rib fractures increased at higher collision speeds, higher decelerations and increased age; the number of sternum fractures increased at higher deceleration and increased age of the test subjects. Seventy-two per cent of the test subjects with sternal fractures had rib fractures; 91% of the subjects with rib fractures had sternal fractures.

[Life threatening complications in alternative medicine--problems in patient education]. / Lebensgefährliche Komplikationen unter Heilpraktikerbehandlung--Aufklärungsprobleme.

The risk of treatment offered by nonmedical practitioners are demonstrated with six casuistic expertise reports. In four cases the treatment had a lethal outcome, because the underlying illnesses had been underestimated or had not been diagnosed. To the authors opinion a patient's consent in a treatment by nonmedical practitioners is inoperative, because a nonmedical practitioner is on principle unable to inform a patient regularly because of his lack of medical knowledge.

[Quasi-static and dynamic bending stress of the pediatric femur for producing a femoral fracture]. / Quasistatische und dynamische Biegebelastung des kindlichen Oberschenkels zur Erzeugung einer Femurfraktur.

At the Institute of Forensic Medicine of the University of Heidelberg, in the years 1986-1988 thigh loading tests were conducted in order to produce fractures in a total of 28 cadavers of babies and children who had died at ages ranging from 1 day to 6 years. In 18 tests a universal strength testing machine was used and each thigh was loaded quasi-statically from the outside with a blunt edge applied to the middle of the femur, bending it to the point of fracture. The loading velocity amounted 50 mm/min with a defined support distance. The breakage load amounted to 470 N in a 6-day-old baby and increased about evenly up to 2920 N in a 6-year-old child; however, in a newborn 2720 N was needed and in a 15-month-old child, 5700 N. The total deformation way ranged from 16 to 60 mm. The main types of fracture that occurred were: complete and incomplete transverse fractures, oblique fractures, Messerer fractures, and spongiosa fractures. Ten children ranging in age from 2 months up to 27 months were submitted to dynamical thigh loading by means of a failing weight impactor and a horizontal impactor. Only in one case did a transverse fracture occur, when the lateral thigh impacted on an edge at a falling height of 70-93 cm. The forces set up amounted to 320-600 N with the falling weight impactor and to 2370 N with the horizontal impactor. These results suggest that fracture of the femur does not occur if a baby or small child falls from a changing table or from an adult's arm.

[The differential diagnosis of sudden infant death or child abuse--a case of fatal hyperthermia]. / Zur Differentialdiagnose plötzlicher Säuglingstod oder Misshandlung--ein Fall von tödlicher Hyperthermie.

During summer-like outdoor temperature, a seven-month old female infant was put into a sleeping bag, wrapped up with a blanket and tied up by her mother and a friend of hers because of unrest and continuous screaming. Prior to that, between 0.30 a.m. and 0.45 a.m., occurred the rectal measurement of temperature: 37.5 degrees C. The infant died one to two hours later. At 10.00 a.m., about 8 hours after death, in the criminal investigations of the police measurements of temperature were made: rectal 38.1 degrees C; in the pharyngeal cavity 29.5 degrees C; surrounding temperature 22.2 degrees C. In the forensic autopsy, symptoms of maltreatment were noticed: hematoma of the skin at buttock and legs, no essential change of organs. The histological investigation showed an interstitial pulmonary oedema, an acute catarrhal tracheobronchitis and hyperaemic inner organs. Concerning the complete investigation results, an acute cardiac insufficiency and circulatory failure due to hyperthermy after wrapping up and immobilisation of the child were assumed to be the cause of death. In consequence of the avowal of the maltreater they were accused of murder and convicted for bodily injury with death. The difficulties of the differential diagnosis SIDS by hyperthermy and mortal hyperthermy due to maltreatment will be discussed. The necessity of a close cooperation between police and forensic physicians is emphasized as prerequisite to clarify such events.