Fatal pulmonary cement embolism following percutaneous vertebroplasty (PVP).

A case of fatal pulmonary embolism with acrylic cement occuring during a percutaneous vertebroplasty on account of a fracture of L1 is described. Autopsy confirmed the presence of large amounts of surgical cement in the paravertebral venous system and in the pulmonary arteries. This rare complication occurred because perivertebral venous cement migration was not recognized during vertebroplasty. To our knowledge, this is the first case of fatal pulmonary embolism caused by surgical cement following a percutaneous vertebroplasty.

Progressive idiopathic bilateral striato-pallido-dentate calcinosis (Fahr's disease) in a person with anabolic steroid abuse.

A 33-year-old male black student suddenly died during a basketball game. His previous medical history, including his neurological status, was unremarkable, but he was known to take anabolic steroids for several years. At autopsy, the cause of death was due to a fresh myocardial infarction. On neuropathological examination, there was extensive bilateral symmetrical calcification involving the basal ganglia as well as the dentate nuclei and the white matter of the cerebellum (Fahr's disease). A possible correlation between anabolic steroid-induced hypercalcemia and brain calcification is discussed.

Fatal intoxication due to dothiepin.

An ingestion of an unknown quantity of Harmomed (dothiepin and diazepam) capsules in a suicide is described. The authors report a new and fast method of analysing and determining the dothiepin concentration in postmortem specimens. Quantitation of dothiepin, and its metabolite desmethyldothiepin was performed by ethyl acetate extraction from alkalinized body fluids before GC-MS analysis. The analyses were performed without any complex sample clean-up steps and with little sample material. Postmortem concentrations of dothiepin, desmethyldothiepin, diazepam and desmethyldiazepam in body fluids are given. The proposed method is a rapid procedure for analysis in cases of deliberate poisoning with the antidepressant drug dothiepin.

Nine STR markers plus amelogenin (AmpFlSTR Profiler Plus): a forensic study in an Austrian population.

Genetic efficiency data of nine short tandem repeat (STR) loci were determined by multiplex PCR using fluorescently labeled primers and subsequent analysis by capillary electrophoresis (ABI 310). For each locus 7-14 alleles were detected. The combined matching probability is about 1 x 10(-11). No deviations from Hardy-Weinberg equilibrium were observed.

GC/MS determination of zolpidem in postmortem specimens in a voluntary intoxication.

An ingestion of an unknown quantity of Ivadal (zolpidem) tablets in a case of drug abuse is described. The authors report a new and fast method of analysing and determining the zolpidem concentration in postmortem specimens. Quantitation of zolpidem was performed by ethyl acetate extraction from alkalinized body fluids before GC/MS analysis. The analyses were performed without any complex sample clean-up steps and with little sample material. Postmortem concentrations of zolpidem in body fluids are given. The proposed method is a rapid procedure of analysis in cases of deliberate poisoning with the sedative-hypnotic drug, zolpidem.

Alleles of the alpha-1-antitrypsin phenotype in patients with aortic aneurysms.

OBJECTIVE: To examine the possible significance of homo- or heterozygous alpha-1-antitrypsin deficiency in the pathogenesis of aortic aneurysms (AA). DESIGN: Prospective investigation. SETTING: University hospital. PATIENTS: 300 controls representing the general population in our region of Southern Germany and 126 patients with aneurysmectomy and graft insertion. METHODS: The alpha-1-antitrypsin phenotype was determined by employing isoelectric focusing. Each patient was also evaluated for hypertension, lipometabolic dysfunction, smoking, hyperuricemia, and diabetes mellitus. MAIN OUTCOME MEASURES: The frequency and distribution of alpha-1-antitrypsin phenotypes and risk factors. RESULTS: 115 of 126 patients presented with one or several of the conventional risk factors: hypertension (61.5%), lipometabolic dysfunction (36.9%), smoking (58.4%), hyperuricemia (13.8%), or diabetes mellitus (6.9%). The following frequencies of alpha-1-antitrypsin phenotypes were determined: PiMM (82.5%), PiMV (4.7%), PiML (1.5%), PiMS (7.1%), PiSS (0.7%), PiMZ (3.0%). Indeed, when compared to the general population (control group) the percentage of the normal PiMM phenotypes was lower in the group of patients with AA (p<0.001). However, in our study this significant difference was not primarily due to the presence of patients homozygous or heterozygous for deficiency alleles PiMS, PiSS and PiMZ (p=0.0523) as has been previously reported, but rather to the high prevalence of the variants PiMV (p<0.005). CONCLUSIONS: Our study suggests that not only Pi-deficiency alleles, previously identified as being associated with AA, but also that Pi variants may play a pivotal role in the pathogenesis of AA.

Fatal chloroquine intoxication.

A suicidal ingestion of an unknown quantity of Resochin (chloroquine) tablets is described. Although chloroquine is known since 1934, intoxications due to chloroquine overdose are rather rare in European countries. The authors report on a new and fast method of analysing and determining the chloroquine concentration in body fluids and postmortem specimens. The analytes were extracted from alkalinized samples into ethyl acetate before GC/MS analysis. The analyses of chloroquine were performed without any complex sample clean-up steps and, in addition, with little sample material. The proposed method resulted in a rapid procedure most useful in cases of deliberate poisoning with the anti-inflammatory and antimalarial drug chloroquine.

[Is heterozygote alpha 1-antitrypsin deficiency a risk factor in the etiology of aortic aneurysm?]. / Ist ein heterozygoter Alpha-1-Antitrypsinmangel ein Risikofaktor in der Atiologie des Aortenaneurysmas?

A potential role of homozygous or heterozygous alpha-1-antitrypsin deficiency alleles Pi*Z or Pi*S in the pathogenesis of aortic aneurysms has been debated in recently published papers. Therefore, we have determined the alpha-1-antitrypsin phenotype in 103 patients with aortic aneurysms using isoelectric focusing. The vast majority of patients (92.2%) had one or more of the established risk factors: hypertension (65.0%), lipometabolic dysfunction (34.9%), smoking (65.0%), hyperuricemia (16.5%) or diabetes mellitus (8.7%). In our patients, the deficiency alleles Pi*Z and Pi*S were more frequent than in the general population of our region, but these differences did not reach statistical significance (PiMS 6.7 versus 3.4%, PiMZ 3.8 versus 2.5%, PiSS 0,9 versus 0.2%). Furthermore, the patients with heterozygous or homozygous antitrypsin deficiency had similar patterns of risk factors to those of the patients with normal phenotypes. In one patient we found a heterozygous PiMZ antitrypsin deficiency associated with Marfan's syndrome. These data do not support the results of recently published studies of fewer cases that suggest a higher prevalence of antitrypsin deficiency alleles in patients with aortic aneurysms. A heterozygous alpha-1-antitrypsin deficiency as a cause or predisposing factor for the development of aortic aneurysms appears to be of little or no importance.

"Tentative" injuries in a homicide.

A homicide caused by blunt trauma to the neck and head is reported. On the left side of the victim's neck were multiple superficial cuts that ran parallel to deeper ones that appeared to be the typical pattern of tentative or hesitation injuries. Further information on the perpetration of the crime could not be obtained from the offender, but it must be assumed that the cuts were made after the victim had already been knocked unconscious by blows or kicks. The considerable blood alcohol concentration of the perpetrator and the rather reduced sharpness of the serrated kitchen knife used probably contributed to the development of these injuries.

[Munchausen syndrome by proxy]. / Münchhausen-by-proxy-Syndrom.

The term "Munchausen by proxy" denotes a special form of factitious disorder and a rare kind of child abuse. We present the case of a 12-year-old boy, whose mother's manipulations culminated in his immobilization in a wheelchair and the implantation of a pacemaker. Problems of diagnosis and clinical management of Munchausen by proxy are discussed.

[Unusual injection site in a drug fatality in prison]. / Bemerkenswerte Lokalisation von Einstichstellen bei einem Drogentodesfall in der Haftanstalt.

A lethal heroin-intoxication of a prisoner with localization of hardly detectable injection marks on the frenulum praeputii is reported. An extensive external examination in particular in cases of death in jail or of drug addicts is necessary to detect unusual signs of intravenous drug addiction.

[DNA extraction from body fluids of cadavers]. / DNA-Extraktion aus Körperflüssigkeiten von Verstorbenen.

DNA of 1 ml Ascites, bile, liquor, pleural-exsudate, pericardial-fluid, synovial-fluid, urine and vitreous humor of sixteen bodies of either sex was isolated. Applying dot-blot-hybridisation black spots were obtained by using total human DNA as DNA-probe (A), if the origin is human. Our results showed, that body-fluids of dead persons contain human DNA, mainly. After rehybridisation with a sex-specific DNA-probe (Y) (pJA 1143) a determination of sex can be performed.

[HIV infection in legal autopsies]. / HIV-Infektion bei gerichtlichen Leichenöffnungen.

Since May 1987 all postmortem cases at the Munich Institute of Forensic Medicine were screened for HIV-antibodies. If possible, testing was carried out before the postmortem examination in order to allow specific protective measures. 19 of 2631 consecutively tested corpses (= 0.7%) were HIV-infected. Since 1986, the onset of occasional testing, we found 29 HIV-infections. 24 of these were men, 5 were women. At least 15 were i.v.-drug abusers und 8 were homosexuals. In post mortem testing of body fluids false-positive results can be recognized easily even by ELISA-testing alone. Additional testing of several body fluids other than blood and especially of brain tissue proved to be valuable and yielded reliable results. Body fluids and tissues of HIV-infected corpses are potentially infectious as long as one week after death.

[Sex determination at the DNA level. Are inter-individual differences in male sex specific quotients to be expected?]. / Geschlectsbestimmung auf DNA-Ebene. Ist mit inter-individuellen Abweichungen beim männlichen geschlechtsspezifischen Quotienten zu rechnen?

A determination of sex was performed for 23 male individuals using sex-specific DNA-probe (Y) (pJA 1143) and total human DNA as DNA-probes (A). The DNA-probes were P32 marked. Applying dot-blot-hybridisation black spots are obtained, the intensity of which may be quantified by a densimeter. The ratio (A/Y) of the intensity of the spots related to total human DNA (A) and to the sex-specific DNA-probe (Y) was calculated. DNA-dilutions of one male individual were prepared in order to determine the ratio (A/Y) for different DNA-concentrations. It was evident that the deviations for the sex-specific quotients of the DNA-dilutions amounts so large-scaled as compared to the quotients of the 23 male individuals, that the method of dot-blot-hybridisation appears not to be applicable to detect an individual component of a particular spot.

[Classification of blood stains inside a car using molecular genetic methods]. / Zuordnung von Blutspuren in einem Wageninneren mit molekulargenetischen Methoden.

Sex-determination of a 1-year old blood-stain was realited by Dot-blot-Hybridisierung. The bloodstains were inside of a car. It was not clear, if the origin is female or male. By using total human DNA-probe (A) and a sex-specific DNA-probe (Y), (pJA 1143), labeled with P32, as soon as the calculation of the sex-specific quotient (A/Y) you could show, the bloodstains must be descended from a man.