Petechial bleedings in sudden infant death.

The autopsy reports of 484 cases of deceased infants (201 females, 283 males) were analysed retrospectively for the existence of external and internal petechial bleedings (PET). The cases were divided into five groups on the basis of the cause of death (sudden infant death syndrome, sepsis, airway infections, asphyxia and trauma). Internal PET (pleural, pericardial, epicardial, thymic and peritoneal) were observed in each group with a lower prevalence in cases of trauma. The highest prevalence of external (cutaneous and conjunctival) PET was detected in cases of asphyxia (38% and 31%, respectively). However, even if with low prevalence, such bleedings were detected in every group. Factors like sex, age, cardiopulmonary resuscitation and its duration did not influence the presence of PET. The detection of external PET at autopsy is a suspicious finding that suggests asphyxia. Because of the possible natural origin of these bleedings, the medicolegal investigation has to be as complete as possible and has to include histology as mandatory.

Coexistence of antiferromagnetic and spin cluster glass order in the magnetoelectric relaxor multiferroic PbFe 0.5 Nb 0.5 O3.

The coexistence of cluster glass with long-range antiferromagnetic order in the relaxor ferroelectric PbFe 0.5 Nb 0.5 O3 is elucidated. While the transition at T(N) = 153 K on the infinite antiferromagnetic cluster induces 3m symmetry with large EH2 magnetoelectric response, the disconnected subspace of isolated Fe3+ ions and finite clusters accommodates the cluster glass below T(g) = 10.6 K with field-induced m' symmetry and EH-type magnetoelectric response. Critical slowing-down, memory and rejuvenation after aging, occurrence of a de Almeida-Thouless phase line, and stretched exponential relaxation of remanence corroborate the glass nature.

Computer-controlled susceptometer for investigating the linear and nonlinear dielectric response.

A fully automatized alternating current (ac) susceptometer is constructed for simultaneous measurements of the phase resolved complex linear and complex nonlinear ac susceptibilities of lossy and dispersive dielectric materials. This relatively simple setup allows measurements over a wide range of experimental variables, such as ac amplitudes up to 40 V, frequencies from 10(-2) to 10(3) Hz, and temperatures from 100 to 600 K utilizing only current/voltage and analog/digital converters and a personal computer. In contrast with the commonly used analysis of the charge accumulated on a standard capacitor in series with the sample our method is based on the analysis of the current flowing directly through the sample. Absence of any capacitive voltage dividers in the measurement circuit eliminates uncontrolled phase shifts. This is why the instrument provides high quality, nonlinear susceptibility data and in particular appears as a very convenient tool for discrimination between continuous and discontinuous phase transitions when determining the sign of the real part of the third order dielectric susceptibility.

Superconducting quantum interference device setup for magnetoelectric measurements.

A commercial superconducting quantum interference device (SQUID) setup (MPMS 5S from Quantum Design), equipped with a magnetic ac susceptibility option, is modified for measurements of the linear magnetoelectric (ME) effect, i.e., of the magnetic moment induced by an applied external electric field in a ME sample. Test measurements on a Cr(2)O(3) (111) single crystal are in excellent agreement with previously reported data of its ME susceptibility. The main advantages of the proposed setup are the improved precision due to the high sensitivity of the SQUID magnetometer in combination with the lock-in technique and a relatively simple experimental realization.

Electric field and aging effects of uniaxial ferroelectrics Sr x Ba1-x Nb2O6 probed by Brillouin scattering.

Static and dynamic heterogeneity of disordered system is one of the current topics in materials science. In disordered ferroelectric materials with random fields, dynamic polar nanoregions (PNRs) appear at Burns temperature and freeze into nanodomain state below Curie temperature (T C). This state is very sensitive to external electric field and aging by which it gradually switches into macrodomain state. However, the role of PNRs in such states below T C is still a puzzling issue of materials science. Electric field and aging effects of uniaxial ferroelectric Sr x Ba1-x Nb2O6 (x = 0.40, SBN40) single crystals were studied using Brillouin scattering to clarify the critical nature of PNRs in domain states below T C. On field heating, a broad anomaly in longitudinal acoustic (LA) velocity at low temperature region was due to an incomplete alignment of nanodomains caused by the interaction between PNRs. A sharp anomaly near T C was attributed to the complete switching of nanodomain to macrodomain state owing to the lack of interaction among PNRs. After isothermal aging below T C, the noticeable increase of LA velocity was observed. It was unaffected by cyclic temperature measurements up to T C, and recovered to initial state outside of a narrow temperature range above and below aging temperature.

Increased polysialic acid neural cell adhesion molecule expression in human hippocampus of heroin addicts.

Chronic exposure to heroin is known to cause cognitive deficits. However, little is known about the underlying molecular mechanisms. It has been suggested that opiate-induced neurotoxicity as well as impaired plasticity and regeneration may be relevant. One of the target regions where regeneration still can be observed in the adult brain is the hippocampus. Since polysialic acid neural cell adhesion molecule is regarded as one of the key players involved in plasticity and regeneration of neural tissue, we analyzed polysialic acid neural cell adhesion molecule expression in the fascia dentate hilus of the human hippocampus of 29 lethally intoxicated heroin addicts and matched controls. Immunohistochemistry with an antibody directed against polysialic acid neural cell adhesion molecule revealed its expression in differently sized cells which could be identified as neurons and glial cells. We observed an increase in the percentage of polysialic acid neural cell adhesion molecule positive neurons in hippocampal hilus of heroin addicts compared with controls (P = 0.001).Interestingly, we also observed polysialic acid neural cell adhesion molecule expression in glial cells as evidenced by double immunofluorescence with glial fibrillary acidic protein and polysialic acid neural cell adhesion molecule using confocal laser scanning microscopy. The fraction of polysialic acid neural cell adhesion molecule positive glial cells was also higher in heroin addicts compared with controls (P = 0.009). In addition, within the group of addicts morphine blood concentrations showed a positive correlation with the percentage of polysialic acid neural cell adhesion molecule positive neurons (P = 0.04; r = 0.547). In conclusion, we observed an increase in polysialic acid neural cell adhesion molecule positive neurons and glial cells in hippocampi of heroin addicts. This might reflect an attempt to repair cell damage due to heroin exposure.

Interactions of proteins and cholesterol with lipids in bilayer membranes.

Mixtures of lipids and protein, the ATPase from rabbit sarcoplasmic reticulum, were studied by freeze-fracture electron microscopy and by measurement of the amount of fluid lipid with the spin label 2,2,6,6-tetramethylpiperidine-1-oxyl (TEM-PO). In dimyristoyl phosphatidylcholine vesicles the protein molecules were randomly distributed above the transition temperature, Tt, of the lipid and aggregated below Tt. For mixtures of dimyristoyl and dipalmitoyl phosphatidylcholine the existence of fluid and solid domains were shown in the temperature interval predicted from earlier TEMPO measurements. When protein was incorporated into this lipid mixture, freeze-fracture particles were randomly distributed in fluid lipids, or aggregated when only solid lipids were present. In mixtures of dimyristoyl phosphatidylcholine with cholesterol the protein was distributed randomly above the transition temperature of the phosphatidylcholine. Below that transition temperature the protein was excluded from a banded phase of solid lipid in the case of 10 mol% cholesterol. In mixtures containing 20 mol% cholesterol, protein molecules formed linear arrays, 50-200 nm in length, around smooth patches of lipid. Phase diagrams for lipid/cholesterol and lipid/protein systems are proposed which account for many of the available data. A model for increasing solidification of lipid around protein molecules or cholesterol above the transition temperature of the lipid is discussed.

Y-SNP-genotyping - a new approach in forensic analysis.

Y-chromosomal DNA polymorphisms, especially Y-STRs are well established in forensic routine case work. The STRs are used for identification in paternity deficiency cases and stain analysis with complicate mixtures of male and female DNA. In contrast, Y-chromosomal SNPs are a new tool in forensic investigations. At present, Y-SNPs are mainly used in molecular anthropology for evolutionary studies. Nevertheless, these markers could also provide very useful information for the analysis of forensic cases. The aim of the presented study was to test Y-SNP-typing for stain analyses using different methods-SNaPshot and MALDI-TOF MS. Both methods are based on the principle of minisequencing. The selected Y-SNP markers are suited to define the most important European haplogroups.

Evaluation of the correlation between time corpses spent in in-ground graves and findings at exhumation.

To determine how long pathological findings persist after burial and which factors play a role in decomposition of a corpse, we evaluated all bodies exhumed under the auspices of the Institute of Legal Medicine at the Hannover Medical School between 1978 and 1997. A total of 87 exhumations (54 men, 33 women) were performed in this period. The time bodies remained buried varied between 5 days and 16.8 years (mean 1.5 years, median 2.3 months). Fifty-six percent of the bodies were exhumed after at most 3 months, 10% remained buried for greater than 3 years. Pathomorphological changes of the soft tissues and the internal organs remained evident after several months, in some cases after several years of burial. Overall, it was possible to evaluate internal organs after 5 years of burial. Bodies became mostly decomposed after approximately 8 years at the earliest, although it was still possible to evaluate some soft tissue remnants after 16.8 years. In stepwise logistic regression, both the length of time the body was buried (p < 0.00005) and the time of year (p < 0.0019) clearly affected the rate of physical change. The variables of sex (p = 0.33), age (p = 0.61) and changes in the integrity of the body before burial (trauma, autopsy before burial; p = 0.15) did not influence the physical state of the body after exhumation. Our data show that much information may be gained from an exhumation even after significant time has passed since burial.

Posttraumatic multiple organ failure--a report on clinical and autopsy findings.

In a retrospective analysis, clinical data and histological specimens were obtained from patients (n = 59) who died of severe injury. Three groups with comparable injury severity were differentiated according to the time of death. In group A (death, within 24 h) (n = 15) despite multiple injuries, patients almost always died from brain injury. Pulmonary failure was the leading cause of death in group B (death, days 2-7) (n = 16). The majority of group C patients (death, > 7 days) (n = 28) died of multiple organ failure. Organ weights at autopsy were all pathologically high but did not show an association with the amount of intravenous volume infused during intensive care. Organ histology revealed signs of interstitial edema and infiltration of polymorphonuclear leukocytes in group B patients especially in the lung, and in all groups to a lower degree in liver and kidney. The distribution of interstitial edema and cell necrosis appeared to be organ-specific. Our data confirm the presence of a generalized inflammatory reaction in patients with severe trauma. The pattern of organ failure, in addition to known pathogenetic changes (mediators, endotoxemia, etc.), appears to be influenced by organ structure and perfusion.

Smoking during pregnancy and poor antenatal care: two major preventable risk factors for sudden infant death syndrome.

BACKGROUND: In this case-control study on sudden infant death syndrome (SIDS), the magnitude of the risk factors 'maternal smoking during pregnancy' and 'poor antenatal care' was assessed and the attributable proportions of SIDS incidence estimated. METHODS: Perinatal data from 190 SIDS cases, who died between 1986 and 1990 at age > 7 days and had a diagnosis of SIDS confirmed by autopsy, were compared to 5920 controls. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were computed by unconditional logistic regression. The attributable risk per cent among the exposed (AR%) and the population attributable risk per cent (PAR%) were calculated. RESULTS: Maternal smoking during pregnancy was associated with a more than twofold risk of SIDS (OR = 2.4; 95% CI: 1.7-3.4) and showed a significant dose-response. Low numbers of antenatal care visits were also associated with an increased risk of SIDS: OR = 1.6 (95% CI: 1.1-2.3) for 4.8 consultations and 2.9 (95% CI: 1.4-5.8) for 0-3 consultations; reference: > 8 consultations. Maternal smoking during pregnancy yielded an AR% of 58% (95% CI: 42-70) and a PAR% of 28% (95% CI: 16-40). The AR% for < or = 8 antenatal care visits versus > 8 consultations was 41% (95% CI: 16-59); the PAR% 10% (95% CI: 3-17). CONCLUSIONS: Assuming causality, our data suggest that a reduction of the prevalence of either risk factor by population-based interventions may yield a worthwhile public health impact in terms of a substantially lower SIDS incidence.

Reliability of SE33 typing by capillary electrophoresis.

A ladder of 24 ACTBP2 (SE33) alleles was separated 175 times by denaturing capillary electrophoresis on an ABI Prism 310 Genetic Analyzer using polymer POP-4. The mean standard deviation of fragment size determination was 0.083 bp. Fragments in the whole allelic range of ACTBP2 could be typed with high precision and reproducibility if adjacent fragments differed by at least two nucleotides. The capacity of resolving 1 bp differences was tested by repeatedly running a ACTBP2*14.2/14.3/31.2/31.3 allelic mixture. The 14.2/14.3 fragment pair could be separated in 98%, the 31.2/31.3 fragment pair only in 65% of all runs. Reliable separation of this difficult fragment mixture could exclusively achieved by using POP-6.

Types of trauma in cases of homicide.

A group of 251 victims of homicide in the years 1978-1988 were examined to determine the causes of their injuries. It was found that 51.4% of homicide victims exhibited evidence of injuries due to blunt trauma, 31.9% were victims of sharp trauma and 29.5% suffered from strangulation. Less common were shootings (18.7%) and other traumata (4.0%). Males were most commonly victims of injuries caused by blunt (51.9%) and sharp (33.6%) trauma, possibly due to more frequent physical confrontations among men. Females also demonstrated injuries due to blunt trauma (50.8%), but strangulation was nearly equal (47.5%). Women were commonly murdered by the aggressor's bare hands within the setting of conflicts in relationships. In 36.7% of all cases, injuries were caused by a combination of aggressive traumas. Combined injuries were common in cases of strangulation (77.3%), blunt trauma (64.3%) and sharp trauma (46.9%), whereas shooting injuries were seldom combined (12.8%) because they were usually fatal alone. Female victims demonstrated combined fatal injuries more frequently than males, probably because conflicts in relationships can cause extreme emotional outbursts and thus lead to the use of multiple aggressive traumatisations.

Vaginorectal impalement injury in a 2-year-old child--caused by sexual abuse or an accident?

Anogenital impalement injuries are rarely encountered in clinical or forensic practice. If seen in children and if incurred under suspect circumstances, sexual abuse must be considered in the differential diagnosis. Here we describe the case of a 2-year-old girl admitted to hospital with a vaginorectal impalement injury. According to the girl's parents, she had slipped in the bathroom and fallen onto the handle of an upright toilet bowl brush. Since a second slight anal injury was present, the parents' account appeared inconsistent. Therefore, physicians from the Institute of Legal Medicine were consulted to investigate the possibility of underlying sexual abuse. Because they could not rule out that the injuries could have been caused by sexual abuse, they recommended having the police immediately examine the site of the purported accident for evidence. The police and forensic investigations, however, verified the parents' account of an accidental injury. Thus, in this case, the initiation of a police inquiry, which is not compulsory in Germany even when sexual abuse is strongly suspected, led to the exoneration of the father.

Intrathoracic and subconjunctival petechiae in sudden infant death syndrome (SIDS).

The frequency and density of intrathoracic and subconjunctival petechiae was studied in 250 cases of SIDS and 69 controls. The control group included 37 infants with natural and 32 infants with traumatic causes of death. Intrathoracic petechiae were found significantly more frequently in the SIDS group (91.2% SIDS; 42% controls; p < 0.001) and were present at a higher density (p < 0.001). Subepicardial and thymic petechiae were detected at high density in older SIDS infants. Subconjunctival petechiae were low in density and found only in 2.4% of the SIDS group but they were detected in 8.1% of the natural death group and 21.9% (p < 0.05) of the lethal trauma group. Subconjunctival petechiae were found at highest density in strangulation. Intrathoracic petechiae are commonly found in SIDS but are not specific for SIDS. Subconjunctival petechiae are typical but not specific for strangulation. In SIDS, subconjunctival petechiae are rare and appear at low density.

The effect of lethal electrical shock on postmortem serum myoglobin concentrations.

Postmortem serum myoglobin concentrations in blood from the femoral vein (peripheral withdrawal) and the heart (central withdrawal) of nine electrical fatalities were compared with those of 74 individuals who had died of other causes. Independent of the cause of death or topographical site, serum myoglobin concentrations rose dramatically with the passage of postmortem time (maximum concentrations in the control group: 975,100 micrograms/l). In 59% of the total sample (electrical fatalities plus controls), serum myoglobin concentrations were higher in the central blood, in the other 41% the concentrations were higher in the peripheral blood. The differences in concentrations between the peripheral and the central withdrawal area correlated with neither the postmortem interval nor the cause of death. Up to the second day postmortem there was a statistically significant difference in serum myoglobin concentrations between electrical fatalities and controls. The individual values within each group, however, varied widely and overlapped between groups. Controls who had also suffered muscle injury (polytrauma, myocardial infarction) did not have significantly higher serum myoglobin concentrations than controls without muscle injury. Myoglobin concentrations appear to be greatly influenced by the extent and duration of the muscle cramps induced by the electrical current. Correct interpretation of serum myoglobin concentrations depends on the knowledge of events surrounding the lethal electrical shock. Postmortem determination of serum myoglobin concentrations alone is, therefore, not sufficient to establish intravital exposure to electrical current and can aid the diagnosis only in special cases.

Unexpected findings in the investigation of an airplane crash.

We report on the discovery at autopsy of an unexpected cause of a crash during landing of a small sports plane with four people on board. Surprisingly, an intact bullet and fragments of the casing were found in the body of the pilot. As expected, autopsy of the other passengers predominantly revealed signs of polytraumatization. In addition, one passenger had a tunnel wound to the left hand and another, a soft tissue tear between the thumb and forefinger of the right hand. These wounds were considered to be associated with a shooting incident in the cabin. The autopsy findings and additional gunpowder trace investigations suggested that the pilot had been incapacitated by a shot from behind, resulting in the plane crash. The present findings underscore the importance of conducting autopsies on all air crash victims.

The time-dependent expression of fibronectin, MRP8, MRP14 and defensin in surgically treated human skin wounds.

Fibronectin, MRP8, MRP14 and defensin were detected immunohistochemically in 46 surgically treated, fresh (hours old) human wounds and in wounds of 13 individuals who died immediately from fatal trauma (airplane crashes or train rollovers). In immediate fatal trauma, it was not possible to detect fibronectin outside of bleeding areas nor could inflammatory cells be visualized in the interstitium using MRP8, MRP14, or defensin antibodies. Fibronectin staining could be regularly demonstrated in wounds at least 20 min-old. Granulocytic infiltrates limited to the perivasal space could be detected 20-30 min after infliction of the wound expressing MRP8, MRP14 and defensin. It was also possible to detect fibronectin networks and MRP8-, MRP14-, and defensin-positive granulocytes and macrophages in particular wounds up to 30 days-old. No differences between the expression of MRP8 and MRP14 could be demonstrated in the wounds, the majority of which were only several hours old. As wound age increased, the number of defensin-positive granulocytes detected decreased. The immunohistochemical detection of fibronectin is a useful way to demonstrate vitality in fresh wounds, beginning about 20-30 min post-trauma. However, detection of MRP8, MRP14 and defensin provides no advantage over the routine histological detection of granulocytes and macrophages in wounds under 1-2 days old.

Tissue distribution of components of the insulin-like growth factor system in sudden infant death and controls.

Growth factors may be involved in sudden infant death (SID). Among these factors, the insulin-like growth factor (IGF) family is important in human fetal and perinatal organ growth and development. In order to detect probable differences in the occurrence and distribution of components of the IGF system, tissue samples from liver, lung, skin, parotid and thyroid gland, gut and cerebellum from SID children (n=9) and controls (n=6) aged between 14 and 258 days of life (mean 105 days) were stained immunohistochemically using antibodies against IGF-I, IGF-II and their specific IGF-I-receptor (IGF-IR). In contrast to controls in hepatocytes of SID children a reduction or an absence of immunoreactivity for IGF-I and IGF-IR and a weaker staining for IGF-II was detected. IGF-II in smooth muscle layers in the gut and IGF-I in epithelial cells in intestinal specimens also showed a reduced immunoreactivity in SID children and those who died traumatic deaths. In the other organs examined no significant differences in the distribution of the insulin-like growth factor system between the groups could be detected, indicating that in SID children no fundamental differences or alterations in the physiology of the IGF system occur. Because of the decreased immunostaining of IGFs in the liver and intestine of SID cases, a local dysregulation may be discussed.

Accidental autoerotic deaths between 1978 and 1997. Institute of Legal Medicine, Medical School Hannover.

Between 1978 and 1997 the Institute of Legal Medicine of the Hannover Medical School examined 17 fatal autoerotic deaths. The incidence for the Hannover region was 0.49 cases per million inhabitants per year. The victims included 17 men with an average age of 36.8 years; a peak in the age distribution was seen between 20 and 29 years. Twelve of the men were found by friends or family in a domestic environment, while other situations in which the victims were found included the victim's own car, a hotel room, a canal embankment, a public parking lot as well as the holding cell of the youth detention center. The men were of varying socioeconomic status and held a number of different types of jobs or still attended school. Five of the men were found completely nude, while five were only undressed below the waist. Four men wore women's clothes and two were fully clothed with exposed genitals. Besides women's clothes, other objects found at the scene included various types of sexual aids, including ropes, chains, metal bars, locks, sex magazines, condoms, plastic bags, rubber items, etc. In four cases blood alcohol levels between 0.1 and 2.5 per thousand (urine alcohol levels between 0.2 and 2.5 per thousand ) were found. Toxicologic examination revealed chloroform, ketamine, a propane-butane gas mixture in one case each, and in two cases cocaine and morphine. Causes of death included central paralysis after strangulation (seven cases), asphyxiation (4), subarachnoid hemorrhage (2), intoxication (1), hypothermia (1), left heart failure (1), and drowning (1). The history, findings at scene, and autopsy findings and, in individual cases, other investigations are of utmost importance to accurately reconstruct a fatal autoerotic accident.