Raman spectroscopy for postmortem interval estimation of human skeletal remains: A scoping review.

Estimating postmortem intervals (PMI) is crucial in forensic investigations, providing insights into criminal cases and determining the time of death. PMI estimation relies on expert experience and a combination of thanatological data and environmental factors but is prone to errors. The lack of reliable methods for assessing PMI in bones and soft tissues necessitates a better understanding of bone decomposition. Several research groups have shown promise in PMI estimation in skeletal remains but lack valid data for forensic cases. Current methods are costly, time-consuming, and unreliable for PMIs over 5 years. Raman spectroscopy (RS) can potentially estimate PMI by studying chemical modifications in bones and teeth correlated with burial time. This review summarizes RS applications, highlighting its potential as an innovative, nondestructive, and fast technique for PMI estimation in forensic medicine.

[False positive death certification. Does the Lazarus phenomenon partly explain false positive death certification by rescue services in Germany, Austria and Switzerland?]. / Falsch-positive Todesfeststellungen. Erklärt das Lazarus-Phänomen teilweise falsch-positive Todesfeststellungen im Rettungsdienst in Deutschland, Osterreich und der Schweiz?

Apart from misdiagnosis, the Lazarus phenomenon, a spontaneous return of circulation after cardiac arrest, is a potential cause for false positive death certification. Because of medicolegal consequences and thus a negative publication bias, the incidence of false positive death certification is unknown. As a false positive death certification results in criminal prosecution and thus media interest, numerous media archives in Germany, Austria and Switzerland were searched for such reports. A total of nine cases of false positive death certification in these three countries were identified since the early 1990s of which eight occurred in an emergency medical service system setting. Apart from a lack of diligence of emergency physicians, a Lazarus phenomenon could be the reason for such incidents. As definite signs of death will not have developed only a few minutes after stopping CPR it might be difficult for an emergency physician to definitely certify a patient's death in an out-of-hospital setting with 100% safety. Thus, prehospital death certification poses a risk of error and subsequent legal prosecution of the emergency physician, as a Lazarus phenomenon may still occur in this phase. Delegation of death certification from emergency physicians to qualified physicians in a follow-up examination might increase both legal safety for emergency physicians in the field and patient safety.

Chromogranin peptides in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder which primarily affects motor neurons. Eight cases of ALS and seven control cases were studied with semiquantitative immunocytochemistry for chromogranin A, chromogranin B and secretogranin II that are soluble constituents of large dense core vesicles, synaptophysin as a membrane protein of small synaptic vesicles and superoxide dismutase 1. Among the chromogranin peptides, the number and staining intensity of motor neurons was highest for chromogranin A. In ALS, the staining intensity for chromogranin peptides and synaptophysin was significantly lower in the ventral horn of ALS patients due to a loss in immunoreactive motor neurons, varicose fibers and varicosities. For all chromogranins, the remaining motor neurons displayed a characteristic staining pattern consisting of an intracellular accumulation of immunoreactivity with a high staining intensity. Confocal microscopy of motor neurons revealed that superoxide dismutase 1-immunopositive intracellular aggregates also contained chromogranin A, chromogranin B and secretogranin II. These findings indicate that there is a loss of small and large dense core vesicles in presynaptic terminals. The intracellular co-occurrence of superoxide dismutase 1 and chromogranins may suggest a functional interaction between these proteins. This study should prompt further experiments to elucidate the role of chromogranins in ALS patients.

Mutations in the sulfonylurea receptor gene in familial persistent hyperinsulinemic hypoglycemia of infancy.

Familial persistent hyperinsulinemic hypoglycemia of infancy (PHHI), an autosomal recessive disorder characterized by unregulated insulin secretion, is linked to chromosome 11p14-15.1. The newly cloned high-affinity sulfonylurea receptor (SUR) gene, a regulator of insulin secretion, was mapped to 11p15.1 by means of fluorescence in situ hybridization. Two separate SUR gene splice site mutations, which segregated with disease phenotype, were identified in affected individuals from nine different families. Both mutations resulted in aberrant processing of the RNA sequence and disruption of the putative second nucleotide binding domain of the SUR protein. Abnormal insulin secretion in PHHI appears to be caused by mutations in the SUR gene.

Atrial natriuretic peptide and CD34 overexpression in human idiopathic dilated cardiomyopathies.

Idiopathic dilated cardiomyopathy (IDCM) is a primary myocardial disease of unknown cause characterized by ventricular chamber enlargement with impaired contractile function. In familial forms of IDCM, mutations of genes coding for cytoskeletal proteins related to force transmission, such as dystrophin, cardiac actin, desmin, and delta-sarcoglycan, have been identified. Here, we report the data of a retrospective investigation carried out to evaluate the expression of atrial natriuretic peptide (ANP), CD34, troponin T and nestin in the myocardium of patients affected with IDCM. Formalin-fixed and paraffin-embedded consecutive tissue sections from the ventricular wall of 10 human normal hearts (NH) following forensic autopsy and 22 IDCM (living explanted hearts) were studied using primary monoclonal antibodies against ANP, CD34, troponin T and nestin by immunohistochemistry. Myocardial fibers were counted independently by three pathologists. Statistics included analysis of variance, log-rank test for Kaplan-Meier analysis, and kappa assessment for intra- and inter-observer variability. ANP and CD34 were significantly overexpressed in IDCM compared to NH (p<0.05). Conversely, troponin T and nestin expression levels did not show significant variation. Inter-observer kappa statistics showed a value of 0.87 and intra-observer kappa statistics a value of 0.98. Evaluation of the marker distribution in the myocardium of patients with IDCM CD34 expression curve was similar to that of troponin T (p<0.0001), although two groups could be identified. Patients with a difference of more than 20 myocardial fibers in expression of CD34 and troponin T had a somewhat less favorable survival although the difference was not significant. The analysis of cells positive for troponin T resulted in a similar number of cardiac fibers between NH and IDCM. This is in agreement with cardiac enlargement present in IDCM, which is due to ventricular dilatation rather than increased number of myocytes. Moreover, the expression of nestin, a marker of activation of myocardial precursors, did not change either, and this may confirm that there are no hyperplastic phenomena in the IDCM pathogenesis. The increase in ANP-positive cells in IDCM could be a consequence of neurohormonal activation due to a decline in the impaired myocyte contractility. Furthermore, since it was already shown that ANP could be important in the control of vascular remodeling, we postulated that the increase in CD34-positive cells might be functionally correlated with the increase in ANP production. Differential expression of CD34 and troponin T might be used in future studies to evaluate their prognostic value.

A study concerning the blood/breath alcohol conversion factor Q: concentration dependency and its applicability in daily routine.

The conversion factor Q, obtained by division of blood alcohol concentration (BAC) by breath alcohol concentration (BrAC) is a widely discussed topic due to its great variance. By Austrian law, regulations frequently require an estimation of a corresponding BAC by a measured BrAC. It is known that Q depends among other things, on the alcohol kinetic state of the person being tested, which mathematically can be transformed to a dependency on the BrAC. Theoretically calculated Q values per BrAC level form a hyperbola shaped curve, thus decreasing with increasing BrAC values. Applying Austrian forensic standards for BAC and BrAC measurements, these calculations were verified in a study under practical conditions with BAC and BrAC data of 390 individuals. Q decreases from 2629 (+/- 455) for BrAC levels < 0.1 mg/l to 2229 (+/- 160) for a BrAC range of 0.4-0.5 mg/l and increases again to 2428 (+/- 124) for BrAC levels > 0.6 mg/l. Since these results were obtained under realistic practical conditions they can be directly applied in routine forensic expert opinion and can eliminate avoidable variances in the calculation of Q.

Network of vascular-associated dendritic cells in intima of healthy young individuals.

In earlier studies, our group has established a new "immunological" hypothesis for atherogenesis supported by experimental and clinical studies showing that inflammatory immunological reactions against heat shock protein 60 initiate the development of atherosclerosis. In the present study, we describe the discovery of a so-far-unknown network of dendritic cells in the innermost layer of arteries, the intima, but not veins of healthy humans and rabbits. The number of these dendritic cells is comparable to that of Langerhans cells in the skin, and dendritic cells show a similar phenotype (CD1a(+) S-100(+) lag(+) CD31(-) CD83(-) CD86(-) and no staining for von Willebrand factor or smooth muscle cell myosin). These vascular-associated dendritic cells accumulate most densely in those arterial regions that are subjected to major hemodynamic stress by turbulent flow conditions and are known to be predisposed for the later development of atherosclerosis. These results open new perspectives for the activation of the immune system within the arterial wall.

Evaluation of gonadal function in 107 intersex patients by means of serum antimüllerian hormone measurement.

Fetal male sexual differentiation is driven by two testicular hormones: testosterone (synthesized by interstitial Leydig cells) and antimüllerian hormone (AMH; produced by Sertoli cells present in the seminiferous tubules). Intersex states result either from gonadal dysgenesis, in which both Leydig and Sertoli cell populations are affected, or from impaired secretion or action of either testosterone or AMH. Until now, only Leydig cell function has been assessed in children with ambiguous genitalia, by means of testosterone assay. To determine whether serum AMH would help in the diagnosis of intersex conditions, we assayed serum AMH levels in 107 patients with ambiguous genitalia of various etiologies. In XY patients, AMH was low when the intersex condition was caused by abnormal testicular determination (including pure and partial gonadal dysgenesis) but was normal or elevated in patients with impaired testosterone secretion, whereas serum testosterone was low in both groups. AMH was also elevated during the first year of life and at puberty in intersex states caused by androgen insensitivity. In 46,XX patients with a normal male phenotype or ambiguous genitalia, in whom the diagnosis of female pseudohermaphroditism had been excluded, serum AMH levels higher than 75 pmol/L were indicative of the presence of testicular tissue and correlated with the mass of functional testicular parenchyma. In conclusion, serum AMH determination is a powerful tool to assess Sertoli cell function in children with intersex states, and it helps to distinguish between defects of male sexual differentiation caused by abnormal testicular determination and those resulting from isolated impairment of testosterone secretion or action.

A previously unrecognized site of local accumulation of mononuclear cells. The vascular-associated lymphoid tissue.

In recent years our laboratory has developed an immunological hypothesis for the pathogenesis of atherosclerosis. We have shown that cellular and humoral immune reactions against heat shock proteins (Hsps) 60/65 expressed on the surface of stressed endothelial cells comprise the initial event in the pathogenesis of this disease. In the course of these studies, we also investigated normal, unaffected arteries for control purposes (carotid bifurcations from children aged 8 weeks to 10 years). This investigation led to the unexpected and previously unknown finding that mononuclear cells pre-exist in the intima at bifurcation sites. Our findings can be summarized as follows: Mononuclear cells are always found in the intima, primarily at sites subjected to major hemodynamic stress. Although the proportion of macrophages vs CD3(+) T-cells differs, overall the latter clearly predominate. Most of the T-cells express the T-cell receptor (TCR)alpha/beta, but TCRgamma/delta cells are also present. We also identified dendritic cells and mast cells in the intima. Analogous to the mucosa-associated lymphoid tissue (MALT) we coined the designation "vascular-associated lymphoid tissue" (VALT) for these newly discovered cellular aggregates in the arterial intima.

Active compression-decompression resuscitation: the influence of different chest geometries on the force transmission.

Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) is performed using a plunger-like suction device applied onto the chest. Forces are partly transferred through the center of this device as well as through the peripheral ring of the plunger's lip seal. We analysed the load transmission distribution of the Ambu CardioPump; therefore a homemade mechanical model was used for simulating different chest geometries. We applied compression forces up to 750N on the device using a 'material testing machine', and we determined the load transferred through the central part of the device and the peripheral ring respectively. The results show that the deeper the sternum is inbeded in the chest the more force is distributed onto the peripheral ring of the plunger's vacuum cup. For a simulated flat chest, 70 N was transferred through the peripheral ring; at a simulated sternal depression of 20 mm, more than 300 N were transferred peripherally. This study points out that different chest geometries have to be considered when using CardioPump.

Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers.

In a prospective study of 38 cadavers of patients older than 18 without previous chest injury or cardiopulmonary resuscitation (CPR), active compression-decompression (ACD) resuscitation manoeuvres were performed to determine possible factors influencing sternal and/or rib fractures. ACD was performed for 60 s, with compression and decompression forces being continuously recorded. A stepwise logistic regression analysis was applied. Factors analyzed were age, gender, use of a compression cushion beneath the piston of the ACD device (Ambu CardioPump), and maximal compression and decompression forces. After ACD, the cadavers were autopsied and thoracic injuries were assessed. There was a significant correlation between sternal fractures and gender (P = 0.008), and between rib fractures and age (P = 0.008). Women were found to have a higher risk for sternal fractures, whereas older patients had a higher risk for rib fractures. Maximal compression force was another factor in sternal and/or rib fracture (P = 0.048). Even though a significantly higher incidence of sternal fractures was observed when the compression cushion was used (P = 0.045), inclusion of this variable in the regression analysis only marginally improved the prediction for correct classification of sternal fractures. In conclusion, when well controlled ACD-CPR is performed in cadavers, age is the most important factor determining the incidence of rib fracture. Sternal fractures were more common in female cadavers.

Increased frequency of thorax injuries with ACD-CPR.

A prospective, randomised out-of-hospital study in a two-tiered system with active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) versus standard (STD) CPR in patients following non-traumatic cardiac arrest was planned to test the hypothesis that ACD-CPR by the first tier may increase the occurrence of ventricular fibrillation as compared with STD-CPR. Furthermore, in a later phase of the study, sternal and rib fractures induced by both CPR methods were determined by extensive autopsy. After enrolling 90 patients the study was terminated because of a high frequency of chest injuries found at autopsy. Forty-two patients received STD-CPR from the first tier and ACD-CPR from the second tier. Thirty-three patients received ACD-CPR only by the first and the second tier, while 15 patients received STD-CPR only from the first and second tiers. In order to obtain a sufficiently large control group for autopsy findings after STD-CPR, STD-CPR was performed in an additional 33 patients within a second period of 4 months. There was no improvement in the number of patients found in ventricular fibrillation after ACD-CPR as compared to STD-CPR performed by the first tier. In patients undergoing autopsy (n = 35) there were significantly more sternal fractures with ACD-CPR versus STD-CPR (14/15 vs. 6/20; P <0.005) and rib fractures (13/15 vs. 11/20; P < 0.05) In conclusion, ACD-CPR appears to cause more CPR-related injuries than does standard CPR, but as a result of a number of limitations on this study, this fact cannot be proven beyond doubt.

The contribution of anulus fibers to torque resistance.

STUDY DESIGN: Anulus fibers of the intervertebral disc oriented in one direction were dissected, and oppositely directed fibers were left intact as a result of a newly developed dissection method. Motion segments were dissected by this way, and motion segments after bilateral facetectomy were loaded in torsion and compared with each other. OBJECTIVES: To assess the contribution of facets and anulus fibers to torque resistance. SUMMARY OF BACKGROUND DATA: Mathematical models predict that torsional stress is transmitted only to those collagene fibers of the anulus that are angled in the direction of the applied torque. Torsion and forward bending or torsion and compression are likely to cause anulus damage. No experimental study that we are aware of has confirmed that anulus fibers are the main structure to resist against torque. METHODS: Pure axial rotation moments were applied on 12 lumbar motion segments. The six components of motion were recorded. Six motion segments were investigated intact after dissection of anulus fibers directed in one direction and after additional bilateral facetectomy. In six motion segments, bilateral facetectomy was performed before anulus dissection. RESULTS: With the application of an axial rotation moment of 8.5 Nm to the left, axial rotation increased 2 degrees after dissection of disc fibers in one direction, and 1.2 degrees after bilateral facetectomy (P = 0.002). In the opposite direction, there were no differences. After both injuries, axial rotation was 7.6 degrees to the left (direction of fiber dissection) and -3.3 degrees to the right (P = 0.0005). CONCLUSION: In lumbar motion segments without degeneration, anulus fibers restrict axial rotation more than the facets.

Biomechanical properties of the human tibia: fracture behavior and morphology.

Standardized biomechanical dynamic load tests were performed to obtain fundamental information on the fracture behavior and morphology of the human tibia. After preparation, the specimens (n = 32) were loaded to breakage by ventral (one side alternately), dorsal, medial or lateral loading on a servo-hydraulic testing machine (Walter und Bai, Löhningen, Switzerland). Primary and secondary fracture lines and fissures were marked differently on the three surfaces of the tibia specimens. They were then videoscanned and digitized on a flatbed scanner to give two-dimensional fracture-line images. Load limits were 2475 to 12,206 Newton. The study revealed both direct fracture patterns with the fracture lines originating from the opposite site of impact, and indirect fracture patterns originating from the distal third of the specimens. Direct fractures occurred in 46% of the specimens after ventral loading, in 80% after medial or lateral loading, and in 100% after dorsal loading. Ventral, medial or lateral loading frequently produced direct wedge fractures of the Messerer type. Dorsal loading resulted in different direct patterns characterized by transverse fractures with longitudinal fissures at the impact site of the loading stamp. Direct transverse fractures also often showed a wedge-shaped pattern due to additional fissures. These were, however, identifiable only after maceration of the specimens and should receive closer attention in forensic practice.

Camphor ingestion for abortion (case report).

The case of a 16-year-old girl who ingested 30 g of camphor dissolved with 250 ml wine to induce abortion is reported. The girl started vomiting 45 min after ingestion, which may have saved her life. Camphor is present in a number of over-the-counter medications, mainly for external application, and is readily available in drugstores. The substance is highly toxic and rapid in onset. The reported human lethal dose is 50 to 500 mg kg-1. Camphor ingestion may lead to abortion because camphor crosses the placenta and fetuses lack the enzymes to hydroxylate and conjugate with glucuronic acid. The girl was charged with intended abortion.

Review of active compression-decompression cardiopulmonary resuscitation (ACD-CPR). Analysis of iatrogenic complications and their biomechanical explanation.

Our review takes a critical look at the active compression-decompression technique (ACD) for cardiopulmonary resuscitation (CPR). ACD-CPR was developed following a report of successful resuscitation performed by a medical amateur using a household plunger. The efficacy of the principle of active decompression has been demonstrated by animal and human studies. Potential iatrogenic complications from the CardioPump were evaluated only when large clinical trials were already underway. Our prospective analysis of autopsy patients and systematic randomised studies in corpses prove that ACD-CPR using the CardioPump considerably increases the rate of iatrogenic complications and especially of sternum fractures. The experimental use of the CardioPump in corpses and the analysis of a variety of different parameters, especially of the rubber cushion pads mounted in the silicone cup to prevent skin abrasions, revealed a statistically significant correlation between sternum fractures and female sex (P < 0.01) and usage of the rubber cushion pad (P = 0.045). Biomechanical studies showed that the transmission of forces from the CardioPump is greatly dependent on chest shape. The lower the sternum is sunken compared with the surrounding structures, the higher the force which is transmitted via the central area of the device onto the sternum. The rubber cushion pad shortens the distance between CardioPump and sternum by 5 mm and therefore increases the sternal loading. Sex differences in the shape of the sternum and especially the thickness may account for the significant correlation between sternum fractures and female sex.

[Multiple organ failure following inhalation of butane gas: a case report]. / Multiorganversagen nach Butangasinhalation: Ein Fallbericht.

Most cases of acute poisoning by butane and other volatile compounds occur in young people as a consequence of substance abuse by inhalation. Clinical symptoms are caused by asphyxia and mainly affect the cardiovascular, respiratory and central nervous system. There are also reported deaths from intoxication of butane inhalation, mostly by cardiac arrhythmia. We report the case of a healthy 14 year-old boy who inhaled butane gas from an aerosol can for refilling cigarette lighters. Despite successful resuscitation and defibrillation, he died two days later from multiple organ failure involving the central nervous system, cardiovascular system, pulmonary system and the liver. Although such incidents are rare in middle European countries, emergency and intensive care medicine staff should be instructed on the consequences and management of butane gas poisoning.

[SIDS prevention program in Tyrol]. / Das SIDS-Vorsorgeprogramm Tirol.

In April 1994, an intervention campaign to reduce the incidence of sudden infant death syndrome (SIDS) was established in the Tyrol. The campaign was intended to increase knowledge concerning risk factors for SIDS in the general community and to improve individual care for infants at risk. In contrast to interventional programmes in other federal states of Austria (i.e. Vorarlberg, Styria), this programme did not utilise polysomnography for identifying infants at risk. A part of the intervention programme was the "Styrian risk questionnaire", a standardised questionnaire concerning risk factors for SIDS. Individual instructions for health care of children at risk (risk score > or = 7) were provided and, if necessary, subscription of home monitoring was performed at the out-patient department (SIDS out-patient service) of the Department of Paediatrics in Innsbruck and other paediatric departments throughout the Tyrol. The educational programme also included information concerning basic life support. Psychological support was offered to parents of SIDS infants. Risk factors for SIDS in the Tyrol before the campaign were assessed in a retrospective case-control study (time period 1984-1994; 99 SIDS infants, 136 controls). The risk of SIDS was markedly reduced when parents had detailed knowledge of the risk factors of SIDS (odds ratio (OR) 0.03; p < 0.001), which emphasises the importance of information and educational programmes. The incidence of SIDS declined after the beginning of the intervention campaign from 1.83/1000 live births (average incidence from 1984-1994) to 0.4/1000 live births and remained at this level thereafter. Post-neonatal mortality also declined from 3.9 to 1.3/1000 live births. The prevalence of the prone sleeping position declined immediately after the campaign (53.7% vs. 5.4%, p < 0.001), as did the frequency of maternal smoking during pregnancy (22.9% vs. 14.5%, p < 0.01). Breast feeding became more popular. In all, the low-cost intervention programme in the Tyrol proved to be highly efficient in reducing the risk of SIDS and in maintaining this effect for several years.

[Alström syndrome--a rare disease of diabetic association]. / Alström-Syndrom--eine seltene Erkrankung aus dem diabetischen Formenkreis.

BACKGROUND: Alström's disease is a rare hereditary multiple-system illness, whereas a second-messenger defect can be assumed. CASE REPORT: We describe a case-the first in Germany of 15 known cases in the world literature-, who suffers from all clinical features, such as non-insulin-dependent diabetes mellitus, retinitis pigmentosa, pancochlear damage of the ears, hypogonadism, obesity and chronic nephropathy, with the exception of acanthosis nigricans. CONCLUSION: Because of the multiplicity of affected organs the diagnosis of Alström's disease is difficult.

[Dental prosthesis--residual alcohol content?]. / Die Zahnprothese--ein Alkoholdepot?

The possible influence of complete or partial dental prosthesis when detecting breath alcohol by means of the breath alcohol analyser "Alcomat" was investigated in a study. During the study, volunteers were asked to rinse their mouths with different types of alcohol such as beer, wine, schnapps and sweets containing alcohol. No influence of the dental prosthesis on the results could be detected. A dental prosthesis neither prolongs the duration of residual alcohol detection, nor does it affect the period of false positive breath alcohol detection. In individual cases the waiting period of 15 minutes between the last alcohol consumption and the breath alcohol test--as legally enforced in Austria--has proved to be too short.