Non-Fatal accidental strangulation in a stroke patient.

Non-fatal strangulation poses a significant concern in clinical forensic medicine. Indeed, surviving victims often present a diverse array of signs and symptoms. In rare instances, acute pathological events that manifest with symptoms similar to those secondary to neck compression (e.g., stroke with subsequent neurological symptoms, etc.) can lead to loss of consciousness, inadvertently resulting in strangulation. Therefore, in this context, forensic investigation plays a crucial role in interpreting the signs and symptoms presented by the victim and determining whether they are the cause or consequence of neck compression. This report presents a case of a middle-aged previously healthy woman who was found by her husband on the bathroom floor and then brought to the medical attention exhibiting signs of neck compression in combination with neurological symptoms. Since a previous episode of domestic violence involving the husband has been recorded in the hospital database, a medico-legal investigation was initiated at the behest of the prosecutor. The integration of all clinical, radiological, forensic pathological findings and circumstantial data allowed the exclusion of homicidal strangulation by ligature perpetrated by the husband, as well as suicidal hanging; instead, it classified the case as an accidental hanging, with a stroke being the underlying cause of the accident. The case provides valuable insights into the complexity of interpreting injuries associated with neck compression and emphasizes the need for comprehensive investigative approach in such cases.

Ethanol Kinetics in the Human Brain Determined by Magnetic Resonance Spectroscopy.

In many parts of the world, ethanol is a widely consumed substance that displays its effect in the brain, the target organ for desired, but also negative impact. In a previous study, the ethanol concentrations were analyzed in different regions of the brain by magnetic resonance spectroscopy (MRS). In this study, the same method is used to demonstrate the kinetics of the ethanol concentration in the human brain after oral ethanol uptake. A drinking study was performed with 10 healthy participants. After the uptake of ethanol in a calculated amount leading to a plasma ethanol concentration of 0.92 g/L (19.95 mM corresponding to a blood ethanol concentration of 0.7 g/kg), brain ethanol concentrations were continuously measured by means of MRS on a 3 Tesla human magnetic resonance imaging (MRI) system. For the data acquisition a single-voxel sLASER sequence was used, with the volume of interest located in the occipital cortex. Intermittently, blood samples were taken and plasma was analyzed for ethanol using headspace gas chromatography with flame ionization detection (HS-GC-FID). The obtained MRS brain ethanol curves showed distinct inter-individual differences; however, a good intra-individual correlation of plasma and brain ethanol concentrations was observed. The results suggest a rapid equilibration between blood and brain. The ethanol concentrations measured in the brain were substantially lower than the measured plasma ethanol results, suggesting an MRS visibility of about 63% for ethanol in brain tissue. The maximum individual ethanol concentrations in the brain (normalized to water content) ranged between 7.1 and 14.1 mM across the cohort, while the highest measured plasma concentrations were in the range between 0.35 g/L (9.41 mM) and 0.95 g/L (20.52 mM).

Incomplete decapitation with exenteration of the brain in a motorcyclist run over by a semitrailer.

Although decapitation is a well-known traumatic mechanism in road traffic deaths, incomplete decapitation of a motorcyclist with exenteration of the brain has not yet been reported in the forensic literature in a victim run over by a vehicle. This paper deals with an autopsy case of a 69-year-old motorcyclist, who had been run over by a semitrailer, as a result of which flattening of the head with extrusion of the brain and incomplete decapitation occurred at the level of the fourth cervical vertebra. This constellation allows to define a special mechanism of accident-related decapitation. Moreover, the case underlines the importance of a multidisciplinary approach for the reconstruction of the accident as well as for the assessment of its judicial consequences. On the suspicion of a hit-and-run accident, simulation tests were performed by technical experts. These tests revealed that the motorcycle may not have been conspicuous for the truck driver prior to and during the accident. Consequently, the charge of manslaughter and failure to render assistance against the truck driver was dropped.

Can PEth be Detected with a Cutoff of 20 ng/mL after Single Alcohol Consumption?

Phosphatidylethanol (PEth) can be determined in capillary blood collected as dried blood spots (DBS) and is a promising direct alcohol biomarker for the determination of drinking habits. Its use for abstinence monitoring needs to be evaluated. Studies with patients undergoing alcohol withdrawal have shown that the elimination of PEth can take up to 2 months. For the determination of PEth 16:0/18:1, a cutoff of 20 ng/mL has been agreed upon in the major US laboratories. However, it is not yet clear what minimum blood alcohol concentrations (BACs) have to be achieved by a single drinking episode to result in PEth concentrations above this cutoff after previous long-term abstinence. To determine whether low drinking amounts can result in a positive PEth concentration above 20 ng/mL, we recruited 12 participants ('social' drinkers). After 4 weeks of abstinence, alcohol was consumed at two separate drinking events with target BACs of 0.5 and 0.3 g/kg, resulting in maximum BACs in the ranges of 0.30-0.63 g/kg and 0.10-0.28 g/kg, respectively. Capillary blood was collected at different time points of the drinking experiment, and PEth was extracted from DBS and analyzed by liquid chromatography-tandem mass spectrometry. Despite drinking doses up to 0.58 g ethanol per kg body weight and reaching BACs of up to 0.63 g/kg, PEth 16:0/18:1 and PEth 16:0/18:2 could not be detected at or above the 20 ng/mL cutoff in any participant at any time after the drinking events. We conclude that after long-term abstinence the cutoff of 20 ng/mL for single alcohol consumption leading to BACs up to 0.63 g/kg is not exceeded.

Interprofessional approach for teaching functional knee joint anatomy.

Profound knowledge in functional and clinical anatomy is a prerequisite for efficient diagnosis in medical practice. However, anatomy teaching does not always consider functional and clinical aspects. Here we introduce a new interprofessional approach to effectively teach the anatomy of the knee joint. The presented teaching approach involves anatomists, orthopaedists and physical therapists to teach anatomy of the knee joint in small groups under functional and clinical aspects. The knee joint courses were implemented during early stages of the medical curriculum and medical students were grouped with students of physical therapy to sensitize students to the importance of interprofessional work. Evaluation results clearly demonstrate that medical students and physical therapy students appreciated this teaching approach. First evaluations of following curricular anatomy exams suggest a benefit of course participants in knee-related multiple choice questions. Together, the interprofessional approach presented here proves to be a suitable approach to teach functional and clinical anatomy of the knee joint and further trains interprofessional work between prospective physicians and physical therapists as a basis for successful healthcare management.