Traumatic venous aneurysm of the popliteal vein with outcome: a case report and review of the literature.

A case of sudden death due to recurrent pulmonary thromboembolism is described. The fatality took place three and a half weeks following blunt trauma to the left popliteal region. The patient died unexpectedly. Autopsy revealed the source of the emboli as a sacciform venous aneurysm of the popliteal vein, an entity seldom described, but important to consider in cases of soft tissue popliteal masses or unexplained pulmonary embolism, especially in otherwise healthy individuals.

The organized subdural blood clot in forensic case work - a case report.

The medico-legal assessment of a subdural haematoma (recent or organized) usually requires some information regarding its cause. Quite often, especially in the absence of a known history of trauma, minor head injuries, which are no longer verifiable, are simply assumed to be the most likely causes. Considering the fact that a subdural haematoma could also be non-traumatic, e.g. in haemorrhagic disorders, cardiac conditions with persistent passive hyperaemia, true inflammatory and degenerative processes of the dura, etc., the medico-legal implication of a possible head injury would require the exclusion of such non-traumatic conditions capable of causing subdural bleeding. In this respect, the case of a 92-year-old man, who suffered from cerebral sclerosis with occasional episodes of confusion and agitation, is briefly discussed. He was reported to have fallen from his bed, was hospitalized and died 2 days later. A head injury was suspected. At autopsy, no skull fractures and no obvious bruises were discovered. Fresh bilateral temporal subdural haematomas were found. These appeared consistent with a suspected head injury sustained as a result of a fall. Fairly large partly organized adherent subdural clots in the parieto-occipital region completely remote from and unconnected with the fresh bitemporal haematomas were also found. Based on the gross pathology and the histology, an attempt is made to assess the possible cause of the organized clots. Some of the findings indicated a possible non-traumatic origin, a consideration which is likely to affect the forensic implications.

[Crime scene and criminal findings site of an unknown cadaver in the field: reconstruction based on traces and clinical findings]. / Tatort oder Fundort mit einer unbekannten Toten im Feld: Rekonstruktion anhand des Spurenbildes und der klinischen Befunde.

The case of a woman with schizophrenia is described who was found dead and nude in a field. To distinguish between a manslaughter, suicide, accident or natural death, details of the scene of death, and the autopsy findings were decisive. In addition, the patient's hospital report was consulted.

Identification of an unknown corpse by means of computed tomography (CT) of the lumbar spine.

For the first time, a case is described in which an unknown corpse is identified by the comparison of antemortem and postmortem computed tomographic (CT) images. A posterolateral disc herniation at L5-S1 on the right side, Schmorl's nodes and a lucency in the ilium were found in identical locations in each case. Additionally there were characteristic morphological similarities in the vertebral bodies, spinous processes, transverse processes and neural arches. In CT identification, as in conventional radiographic identification, one must try to reproduce comparable scanning conditions and images because apparent differences in the roentgenological morphology can occur as a result of different gantry angles or slice thicknesses.

Sudden death due to cardiac sarcoidosis in a case of suspected homicide.

In a case of suspected homicide death due to natural causes--cardiac death (SCD)--was found at autopsy. Despite an extensive replacement of myocardial tissue by sarcoid granulomata there was no history of cardiac dysfunction or preceding symptoms. The transmurally infiltrating granulomata and the concomitant fibrosis were predominantly confluent. They occupied vast areas within the interventricular septum and the adjacent posterior wall of the left ventricle. The only other organs involved were mediastinal lymph nodes, which appeared macroscopically normal.

Diethylene glycol (DEG)-associated myocardial changes: a pilot investigation of chronic intoxication in guinea-pigs.

The myocardium of guinea pigs fed on sublethal doses of diethylene glycol (DEG) over a period of 2-11 days was examined for microscopical and ultrastructural changes. Coagulative myocytolysis and loss of myofibrils, not observed in the controls, was patchily distributed throughout the myocardium. The accompanying ultrastructural features included swelling, pleomorphism and hyperplasia of mitochondria with an associated distension of the interfibrillary spaces and a displacement, distortion and rupture of adjacent myofibrils.

Estimating the total number of lymphatic valves in infant lungs with the fractionator.

The fractionator is illustrated by means of a biomedical example involving the estimation of the number of lymphatic valves in lungs of infants who had died from sudden infant death syndrome (SIDS) and other known causes. The method is unbiased irrespective of tissue deformations and it does not require external information such as section thickness. An upper bound of the coefficient of error of the estimate of the number of valves within one lung was 6.5%, despite the fact that the number of valves counted per lung at the last stage ranged between 11 and 37 only. The upper bound includes the biological variation of the number of valves among infant lungs. Some theoretical remarks are also made on the efficiency of the fractionator. It is suggested, for instance, that the initial sampling stages cause more impact on the precision of the final estimator than the subsequent stages, and that an optimal arrangement of fragments submitted to systematic sampling should have the smallest fragments at the ends, with fragment contents increasing smoothly toward the middle of the series.

[WHO basic classification in forensic medicine]. / Die WHO-Grundklassifikation in der Rechtsmedizin.

The internationally used WHO-basic tabulation list of causes of diseases and death is presented in a modified version for forensic medicine. The findings of postmortems are to be indexed with this code and put into a database. We would like to suggest that as many institutes as possible use this code and collaborate to discuss further modifications.

[Sudden infant death--fatal poisoning with pheniramine]. / Plötzlicher Säuglingstod--letale Intoxikation mit Pheniramin.

A case of unintentional fatal intoxication of a 10 month-old baby with the anti-histamine Pheniramine (Avil) is reported. On the face value and without an autopsy this case parallels familiar cases of SIDS and had for this reason been certified as such. Autopsy, however, revealed 32 partly dissolved tablets which proved to be Phenyramine. High concentrations of Pheniramine were found in body fluids and various tissues. According to official investigations, the tablets were offered to the baby by his 3 1/2 year old sister who probably believed they were sweets.

[Cellular components in interstitial lung tissue in sudden infant death--immunohistochemical characterization]. / Zelluläre Komponenten im Lungeninterstitium beim plötzlichen Kindestod--Immunhistochemische Charakterisierung.

Monoclonal antibodies against the Leucocyte Common Antigens LC and MAC-387 expressed by lymphocytes, mononuclear phagocytes and polymorphonuclears failed to mark the cells of the pulmonary interstitial connective tissue in cases of SIDS. Controls with interstitial pneumonia showed clearly marked inflammatory cells. Although focal proliferation of cells was frequently observed in the vicinity of distended lymphatics in SIDS cases, an inflammatory origin as in the cases of interstitial pneumonia could not be confirmed. A relationship between interstitial edema and a non-inflammatory proliferation of the cells is discussed.

[The pathomorphology of chronic alcohol-associated myocardial changes]. / Zur Pathomorphologie chronischer alkohol-assoziierter Myokardveränderungen.

Forensic cases of sudden cardiac death were reviewed from the point of view of a history of alcohol consumption. A group of known cases of chronic alcoholism and another group of cases known to have been normal social drinkers without evidence of chronic alcoholism were selected. Cases with evidence of hypertension, ischemic or coronary heart disease, as well as cases with positive toxicological findings, were excluded. Applying the same criteria, cases of sudden death from other causes without a known history of alcohol consumption were selected to form a control group. With particular reference to histological myocardial changes, which are often documented in association with alcohol consumption, no noteworthy differences were found between the two major groups despite the significantly much lower frequency in the control group.

[Forensic significance of lesions of the sinus node in cases of sudden death of unknown origin]. / Zum forensischen Stellenwert von Läsionen des Sinusknotens bei unklaren plötzlichen Todesfällen.

Report on a systematical histological investigation of sinu-atrial nodes in strongly suspected cases of cardiac death in which no pertinent myocardial or coronary changes were found. In over 40% of the cases studied there were histopathological changes in the mixed tissue components of the sinu-atrial node which were highly suggestive of severe or fatal functional impairment.

Pulmonary lymphatics in SIDS--a comparative morphometric study.

Pulmonary lymphatics in a group of SIDS cases were compared with a control group of a similar age distribution. The causes of death in the controls were known to be associated with varying degrees of pulmonary edema. The surface areas of pleural, interstitial, peribronchial, periarterial and perivenous lymphatics were planimetrically measured. The data were statistically tested. The tests showed that the pulmonary lymphatics of the SIDS group were significantly more distended than those of the control group as expressed by highly significant differences in their surface areas. On the whole 2142 lymphatics were measured; 1255 in the SIDS group, which consisted of slides from 10 cases and 887 in the control group which consisted of slides from 11 controls. Although the sample size imposes a limit on the general applicability of the results, the clear distinction between the two groups as shown by the tests do indicate a possible feature of SIDS--lymphatic stasis--which might be secondary to some impairment of lymphatic drainage. This in turn could induce subtle fibrotic changes in the connective tissue framework of these lungs. The results are presented in the light of the forensic significance of the signs of asphyxia frequently found in SIDS and the diagnostic difficulties encountered in differentiating between SIDS and mechanical asphyxia e.g. due to smothering.

[Quantitative polarization microscopy demonstration of collagen type I and type III in histologic paraffin sections]. / Zur quantitativen polarisationsmikroskopischen Darstellung von Kollagen Typ I und Typ III an histologischen Paraffinschnitten.

The industrial dye Solophenyl Red 3 BL (Ciba-Geigy) dissolved in a saturated aquaeous solution of picric acid has proved suitable for differentiating between collagen types I and III in histological sections. When examined under polarization microscopy, type I fibers are radiant orange while type III fibers are green. Using 5 micron paraffin sections, an optimal staining procedure was determined: sections were first stained with Resorcin Fuchsin for elastic fibers and with Celestin Blue/Mayer's Hematoxylin for nuclear structures. The staining was then completed with 0.1 g Solophenyl Red/100 ml saturated aqueous solution of picric acid for 60 min at a pH value of 1.25. It was shown that the dye stained collagen selectively. With the aid of a photomultiplier, the spectral distribution of a series of lung sections adequately stained according to the optimized procedure was carried out using a monochromator and an interference filter, respectively. Both methods yielded identical peaks at 590 nm for the orange colored light of collagen type I and 490 nm for the green light of collagen type III. Application of appropriate filters permitted the intensity of the orange and green light at 590 nm and 490 nm to be measured. Long postmortem intervals did not affect the measured values. Quantitative inferences on the ratio of collagen I to collagen III could then be deduced from the ratio of the intensity of orange to green light. This index I/III is often applied in the diagnosis of discrete fibrotic changes in various organs.

[Fatal lung hemorrhage in complex pulmonary angiodysplasia in a case of mongolism]. / Tödliche Lungenblutung bei komplexer pulmonaler Angiodysplasie in einem Fall von Mongolismus.

A case of sudden and unexpected death of a boy with Down-Syndrome is reported. Death was due to acute excessive haemorrhage from the lungs. There were no cardiac anomalies. Histology revealed in addition to mediahyperplasia, intimaproliferation and occlusions, multiple foci of anomalous ectatic blood vessels predominantly in the lungs, some of which ruptured and bled into adjacent airways. Evidence of previous less severe bleeding episodes was present. Further investigation showed a familial occurrence of the blood vessel anomaly.

[Changes in the ratio of collagen type I and III in the interlobular interstitium of the lung in sudden infant death--a pilot study]. / Uber Veränderungen des Mengenverhältnisses von Kollagen Typ I und III im interlobulären Lungeninterstitium beim plötzlichen Kindstod--eine Pilotstudie.

In a blind study the interlobular interstitial connective tissue in paraffin embedded lung sections from 45 autopsy cases aged under 2 years (23 SIDS and 22 Non-SIDS) were investigated with the aim of determining the collagen type I:type III ratio by means of polarimetric evaluation. Sections were stained with Resorcin-Fuchsin for elastin fibres, Celestine Blue/Mayer's Haematoxylin for nuclear details and with Solophenyl Red 3 BL in saturated picric acid solution for the differential staining of type I and type III collagen fibres for polarization microscopy. The type I fibres were orange and the type III fibres green in colour. The spectral distribution of the coloured polarized light from the sections was determined and peaks were evident at the wavelengths 590 nm for the orange coloured light of type I and 490 nm for the green coloured light of type III collagen. With corresponding filtres the intensities of the orange and green emissions were separately measured at several points adjacent to lymphatic vessels. The ratio collagen I/III, deduced from the ratio of the intensities of orange to green light, was significantly higher in the SIDS-group than in the Non-SIDS-group (a = 0.001) due to the increase in the amount of collagen type I and could indicate an insiduous fibrosis resulting from lymphostasis.

[Changes in the lung connective tissue framework in sudden infant death (SIDS)]. / Lungengerüstveränderungen beim plötzlichen Kindestod (SIDS).

Light microscopy findings are reported on the interstitial connective tissue framework of 45 lungs from babies who died within the first 2 years of life. Thirty were confirmed cases of SIDS and 15 were controls of similar age who died of known causes. The stains applied were H & E, PAS, Prussian blue, Elastica van Gieson, Trichrom (Masson-Goldner), Gomori's silver methenamine and Picro-Sirius polarization (modified). Particular attention was paid to type I and type III collagen, reticulin fibers and ground substance. All investigated cases showed evidence of chronic recurrent interstitial edema in a highly significant frequency and intensity in contrast to the controls. Areas of recent and persistent lymphedema were observed, some of them with reactive fibroplastic activity, which tended towards gradual fibrosis. These changes were irregularly distributed and frequently involved the mural interstitium. Considering the effects of such changes on expansibility, ventilation and perfusion of the lungs, as well as the impairment of gas diffusion, the findings described could be significant in the forensic evaluation of the signs of asphyxia found in most cases of SIDS.

[2 cases of pericardial tamponade caused by migration of fracture wires from the sternoclavicular joint]. / Uber zwei Fälle von Herzbeuteltamponade infolge Migration von Spickdrähten aus dem Sternoclaviculargelenk.

Two cases of dislocation of the sternoclavicular joint are reported in which migrating nails caused fatal heart tamponade. In both cases death occurred due to fracture nails which had not been bent or secured against migration in some way, and X-ray control had been inadequate. The doctors were charged with manslaughter by negligence since they had not exercised reasonable care as would have been required in those circumstances. As a result of the two attending physicians, trials, it is concluded when that operative osteosynthesis techniques are applied in order to affix dislocations of the sternoclavicular joint, migration of the osteosynthesis material must be prevented by adequate measures and that X-rays have to be taken within short intervals from different planes. Osteosynthesis material should be removed as soon as possible.

Fatal case of propoxyphene overdose. Morphological and toxicological findings.

The pathomorphological and toxicological findings of a case of fatal overdose of propoxyphene are reported. The chemico-toxicological findings revealed the presence of only one active substance that has been administered (in an amount of not less than 1.5 g dextropropoxyphene) in form of an analgesic tablet preparation (marketed under the trade name Dolo-Neurotrat), in which it represents the main active constituent. The most striking histological findings are the changes in the myocardium which are consistent with cardiotoxicity. It is suggested that an estimation of shock duration by means of pathomorphological findings in combination with toxicological and other data be utilised for survival time determination.