A gas chromatographic analysis of phosphine in biological material in a case of suicide.

In a suicide committed using aluminium phosphide (AlP) the liberated toxic phosphine gas was detected in post-mortem specimens using a headspace gas chromatographic procedure with a nitrogen-phosphorous detector (HS-GC/NPD). At autopsy a direct sampling into airtight headspace vials for a later analysis is recommended. AlP has to be considered a potent pesticide and its use and availability should be restricted as much as possible.

Pancreatic changes in cases of death due to hypothermia.

Several morphological alterations of the pancreatic tissue have been described as common findings in hypothermia (e.g. bleedings, pancreatitis, vacuoles). The frequency of these findings varies a lot. It was the aim of this study to clarify the kind and frequency of pancreatic changes in cases of death due to hypothermia. The autopsy reports of 143 cases of fatal hypothermia were, retrospectively, evaluated with regard to describe macroscopic findings in the pancreas. Additionally, microscopic investigations of tissue samples of the pancreas were carried out in 62 cases. As a control group, pancreatic samples of 25 autopsy cases without hypothermia and without alcoholism were collected. Additionally, pancreatic samples of 25 further autopsy cases with an alcoholic disease in the case history were investigated. In only 5 out of 143 cases of the study group, macroscopic bleedings in the pancreas were described. One case of acute and one of chronic pancreatitis was found in the autopsy reports. In 11 (17.7%) out of 62 cases, microscopic investigations yielded bleedings in the pancreatic tissue and in 24 (38.7%) out of 62 cases, optically empty vacuoles in the adenoid cells were found. In 15 out of 62 cases (24.2%), autolysis was too pronounced to gain utilisable results. In the control group without alcoholism, 12 out of 25 cases (48%) were diagnosed without pathological findings, five cases showed bleedings, one case an acute pancreatitis, one case a chronic pancreatitis and in six cases, the pancreatic tissue was autolytic. Vacuoles in the adenoid cells were not found. In the additional collective with alcoholism in the case history, 13 cases presented signs of an acute or a chronic pancreatitis. In 3 out of these 13 cases, vacuoles in the adenoid cells were found, but no case with vacuoles and without signs of a chronic pancreatitis was observed. The high frequency of pancreatic bleedings in cases of fatal hypothermia as described in the literature cannot be confirmed by our investigations. Only the vacuoles in the adenoid cells of the pancreas seem to be an additional sign of death due to hypothermia or associated with hypothermia.

Does the frontal airbag avoid thoracic injury?

INTRODUCTION: The airbag is an established car safety device. However, recent studies pointed out that even the airbag might cause injuries. Nevertheless, most physicians do consider a lower risk in accident victims sustaining severe injury of the chest, when a deployed frontal airbag has been reported. We set out to verify the frequency and pattern of thoracic injury in car drivers protected by a frontal airbag during traffic accidents. METHODS: This investigation was conducted as part of a prospective surveillance analyzing traffic accidents. Enrolled were car drivers included in a databank between January 2001 and December 2004 consecutively. The chance for sustaining chest injury with or without a frontal airbag was described using the relative risk. RESULTS: A total of 188 car drivers were included in the analysis. In 54 (28.7%) cases a deployed airbag and in 134 (71.3%) the absence of an airbag has been documented. Out of those cases 16 (29.6%) drivers with airbag and 30 (22.4%) without airbag sustained a chest injury. The mean abbreviated injury scale (AIS) of chest injuries in drivers with deployed airbag was 2.3 (1-5; SD +/- 1.45; mean injury severity scale [ISS] 21.1 [SD +/- 17.18]), in drivers without airbag 1.6 (1-4; SD +/- 1.12; mean ISS 15.8 [SD +/- 20.6]). For belted drivers with an airbag the relative risk to sustain chest injury was 1.96 compared to those without an airbag. CONCLUSIONS: The airbag does not avoid chest injury definitively. Much more, it has been demonstrated that the relative risk to sustain relevant thoracic injury seems to be almost higher in restrained drivers with a frontal airbag.

Age distribution of latent herpes simplex virus 1 and varicella-zoster virus genome in human nervous tissue.

Latency in nervous tissue caused by herpes simplex virus 1 (HSV-1) and by varicella-zoster virus (VZV) is an intriguing feature of herpes-virus' neurotropism. HSV-1 and VZV latency are the causes of ophthalmic zoster and recurrent HSV infections in the distributions of the trigeminal branches. HSV-1 neuronal latency may play a role in the etiopathogenesis of HSV encephalitis. We attempted to determine the prevalence and age distribution of VZV and HSV latency. We applied nested polymerase chain reaction (PCR) assays to detect HSV-1 and VZV genome in trigeminal ganglia and olfactory bulbs which were obtained from 109 human corpses at forensic postmortems. HSV-1 latency was found in 72.5% of trigeminal ganglia and in 15.5% of olfactory bulbs. VZV latency was 63.3% in trigeminal ganglia and 1% in olfactory bulbs. Simultaneous latency of VZV and HSV genome occurs in 48.8% of trigeminal ganglia. The age-group specific prevalence of HSV neuronal latency increases from 18.2% in 0-20 years to reach finally 100% in persons older than 60 years. Age specific prevalences of VZV peaked for a first time with 82% between 21-30 years, fell to 50% for 40-50 years, and rose to 89% for 71-80 years. If the latent trigeminal ganglion HSV-1 genome were the source of endogenously acquired encephalitis, the peak incidence of HSV encephalitis in older subjects correlates with our findings. Increased VZV latency prevalence in nervous tissue of younger people without subsequent disease indicates sufficient immune surveillance.

["Iatrogenic" fatal gas gangrene infection]. / Beitrag zur "iatrogenen" letalen Gasbrandinfektion.

The problems associated with lethal gas gangrene infections that arise in connection with medical treatment are described and discussed, based on our own observations and on cases reported in the literature. Special emphasis is placed on questions relating to causality and responsibility. The difficulties encountered in the evaluation of such "iatrogenic" gas gangrene infections are due to the fact that clostridia occur ubiquitously, i.e. that they also reside in the human organism, for instance on the skin. For this reason a positive bacteriological diagnosis of gas gangrene does not necessarily mean that a clinically relevant infection and/or disease state is present at the same time. The implications for morphological practice arising from this situation are discussed, especially with regard to the significance of the intravital, agonal or postmortem bacteriological diagnosis of gas gangrene. Questions concerning the obligation to report such cases when encountered during forensic autopsies are also addressed.

[Sudden death caused by malignant testicular tumors]. / Plötzlicher Tod durch maligne Hodentumoren.

Sudden unexpected death of apparent healthy young males due to malignant tumours are extremely rare in forensic autopsy material. We report on three such cases dying of pulmonary embolism caused by metastazing tumour of the testis. In each subject the tumour was localized to the right testis and consisted of two types of tumour tissue: Seminoma and embryonic carcinoma, the latter of which was always the metastazing one. Each of the cases represent different aspects of forensic medicine. In the first subject the tumour had remained undiagnosed in a recent medical examination. The second one underwent surgery because of acute abdomen and died intraoperatively and the third one died suddenly during antibiotic treatment, because the tumour had been mistakenly diagnosed as orchitis.

[Traumatic, ischemic and toxic rhabdomyolysis]. / Traumatische, ischämische und toxische Rhabdomyolyse.

Rhabdomyolysis with myoglobinuria and acute renal failure can develop from a variety of traumatic and nontraumatic reasons and the clinical as well as forensic significance of it may vary from an epiphenomenon with an excellent prognosis to the cause of death. We present altogether four autopsy cases in two of which the rhabdomyolysis was associated with an acute intoxication with alcohol (male, 41 years of age) or amitriptyline in combination with chlordiazepoxide (male, 52 years of age). In both these subjects the myoglobinuria was a secondary finding and not the cause of death. In the other two subjects the outcome of rhabdomyolysis associated myoglobinuria was lethal. In the first one (female, 18 years of age) the muscle injury was traumatic, caused by long-lasting compression and ischaemia of the lower limbs (classical crush-syndrome), the outcome of which in spite of the adequate therapy was lethal. In the other one (male, 20 years of age) the rhabdomyolytic myoglobinuria and subsequent acute renal failure occurred postoperatively after reconstructive surgery of one hand and the interruption of blood circulation to the corresponding arm for the time of a nerve reconstruction. The recovery of the patient was complicated by continuing electrolyte disturbances associated with metastatic tissue calcification, especially of the lungs, leading to progressive respiratory insufficiency and eventually to death.

[Iatrogenic hemorrhagic complications in gynecologic laparoscopies--report of 2 cases with a fatal course]. / Iatrogene Blutungskomplikationen bei gynäkologischen Laparoskopien--Bericht über zwei Fälle mit tödlichem Verlauf.

Endoscopy and laparoscopy are part of modern gynecology. Using them, however, implies the occurrence of certain complications. The rate of complications, according to international statistics, about 3.5 per thousand with a lethality rate of 0.02 per thousand, is significantly influenced by the practitioner's personal experience and skill. The most relevant complication is hemorrhage. As a result of the patient's position, the aorta and pelvic arteries are most endangered. The symptoms of complications should be kept in mind by the physician, as well as the methods of rendering immediate medical support. Two cases with a fatal outcome are illustrated, which were caused by ignorance of an acute and slow hemorrhage, respectively. Publishing them could help to prevent further such cases.