[Functionnal revalidation of patients with Age-related Macular Degeneration]. / Prise en charge en revalidation fonctionnelle de la dégénérescence maculaire liée à l'âge.

Age-related Macular Degeneration (AMD) is the leading cause of blindness and visual impairment in developed countries for people older than 50 years. This disease can lead to loss of autonomy, which can be managed in Functional Revalidation Center.

La Dégénérescence Maculaire liée à l'Age (DMLA) est la principale cause de malvoyance et de cécité chez les patients de plus de 50 ans dans les pays industrialisés. Cette maladie est à l'origine d'une perte d'autonomie dans les tâches de la vie quotidienne qui peut faire l'objet d'une prise en charge en Centre de Revalidation Fonctionnelle.

[Clinical case of the month. Sudden orbital cellulitis in the emergency unit]. / Le cas clinique du mois. Exophtalmie aiguë au service des urgences.

We report a case of infectious orbital cellulitis complicating a frontal sinusitis in a seventy-three-year-old patient. The onset of this orbital complication was sudden. A clinical examination and an orbital CT-scan allowed an early diagnosis. Despite an appropriate surgical and medical treatment, the patient retains an altered visual function. We consider the clinical causes and consequences of orbital cellulitis as well as their surgical indications.

Lacrimal gland swelling in a young African woman.

We describe an African patient with sarcoidosis involving the lacrimal glands. Gallium scintigraphy showed the so-called "panda sign".

[Periorbital necrotizing fasciitis: a complication of a dacryocystorhinostomy]. / Fasciite nécrosante périorbitaire: complication d'une dacryocystorhinostomie.

We report a rare case of periorbital necrotizing fasciitis following a dacryocystorhinostomy procedure. We describe the common features of this rare infection of the skin and subcutaneous tissues and discuss the different management strategies as well as the controversial role of anti-inflammatory medication in treating this condition.

[Clinical case of the month. Bilateral optic neuropathy secondary to biphosphonate therapy]. / Neuropathie optique bilatérale secondaire à la prise de biphosphonates.

Ocular side effects associated with biphosphonates have been described. Conjunctivitis, uveitis and scleritis are the most common adverse events. We report a case of bilateral toxic optic neuropathy with optic dies edema occurring soon after a pamidronate intravenous infusion in a patient who previously presented both a conjunctivitis and an uveitis of moderate intensity associated with alendronate therapy.

Comparison of laser and mercury-arc lamp for the detection of body fluids on different substrates.

The performance of two detection techniques for body fluids, the Spectra-Physics(R) Revealtrade mark portable forensic laser system and the mercury-arc lamp Lumatec Superlite 400, was evaluated with various biological stains on different substrates. Serial dilutions of neat, 1/10, 1/100 and 1/1,000 using fluid semen, saliva, urine and blood were applied on glazed tiles, glass, PVC, wood, metal, stone, formica, carpet and cotton. Apart from the fact that blood traces were not detectable with the laser, both light sources showed comparable results regarding their detection capability. Clear advantages of the Lumatec Superlite 400, however, are its lower size, weight, purchase costs and the possibility to operate this light source by battery.

Severity and duration of mental deficiency symptoms after intravenous administration of propofol.

The severity and duration of cognitive performance capacity deficits after intravenous administration of propofol were determined using the validated psychological test procedure syndrome short test (SKT), a simple reaction test and original driving licence exam questions. The test battery was performed before, immediately after, as well as 1 and 2 h after propofol administration in 23 persons. Immediately after propofol anaesthesia, six individuals had a slight performance loss, and four subjects showed mild deficits, consistent with medium organic neuropsychologic disorder or dementia. The status of the subjects rapidly changed for the better, and 2 h after propofol anaesthesia, only one person (4%) showed slight deficits of memory and attention. Therefore, it is suggested that patients refrain from any participation in road traffic for at least 2 h after propofol anaesthesia. Driving a car should not be admitted until an interval of 6 h has elapsed.

Hypoxic changes in Purkinje cells of the human cerebellum.

The significance of both Purkinje cell numbers and various neuronal changes for the diagnosis and timing of hypoxic-induced brain lesions was investigated in tissue samples from the cerebellar cortex of 52 individuals with a history of acute or prolonged cerebral hypoxia/ischemia before death. Furthermore, the area of the Purkinje cell somata (PC size) was measured using an automatic image processing and analysis system (LEICA QWin). Significantly reduced numbers of Purkinje cells (<6 cells/unit length of 1 mm) and a decreased portion (<50%) of intact Purkinje cells could be detected in individuals with a period of resuscitation of at least 2 h after acute circulatory arrest. Average cell numbers of less than 4 cells/unit were found in individuals who suffered from diffuse brain swelling and were ventilated for at least 3 days, as well as in individuals who died of brain death. Moreover, the Purkinje cells in these cases exhibited shrunken somata compared to the controls. Specimens that were stored at room temperature up to 30 h after removal at autopsy showed no significant autolytic changes of the Purkinje cells. After 46 h, however, reduced Purkinje cell numbers and shrunken cell bodies were found.

Fatal impalement injury of the head due to a curtain rail.

During a dispute, a boy was injured by a curtain rail which penetrated the skull in the left frontal region and led to severe brain injury. Despite intensive medical care, death occurred 10 days later due to malignant cerebral edema. With regard to the question whether the trauma resulted from throwing or pushing, some biomechanical aspects are discussed including individual morphologic findings as well as the kinetic energy required for penetrating the skull. According to the calculated data, we conclude that the velocity necessary for penetrating could be reached by throwing the curtain rail.

Value of morphological parameters for grading of brain swelling.

This study investigated the value of both gross features and histological findings for grading of brain swelling. For this purpose, the grooving of the temporal gyri (unci) as well as the extension of the cones at the basal part of the cerebellum were measured in 42 brains obtained at autopsy. Furthermore, the distension of perivascular spaces in tissue samples from seven different regions of the brains was evaluated histologically, assisted by an automatic image processing and analysis system. In each individual, the normal range of brain weight was calculated on the basis of the body height, using the formulae by Röthig and Schaarschmidt. The difference between this calculated (normal) value and the brain weight evaluated at autopsy was considered as a reliable criterion for the grade of brain swelling. There was no statistical evidence of a positive correlation between the various parameters. Hence, it can be concluded that both gross section and histological findings are of minimal significance for grading of brain swelling.

On-site testing of illicit drugs: the use of the drug-testing device "Toxiquick".

Since 1998, driving under the influence of drugs such as amphetamine, MDMA, MDE, cannabis, cocaine, heroine and morphine is sanctioned due to Section 24a of the Road Traffic Regulations of Germany. Therefore, from December 2000 to June 2002 altogether 751 roadside tests with the immunochemical test device Toxiquick were conducted on 302 drivers (273 male and 29 female) on oral fluid samples obtained during control actions in Franconia. The results of the tests are compared to the results obtained through quantification of corresponding blood samples by GC/MS. In general, in 75% the roadside test produced correct results and therefore gave helpful assistance to the police officers into the right direction regarding drug abuse. Except for cannabinoids, the number of false negative results was relatively small, whereas false positive results ranged between 32.2% for opiates and 10.7% for benzoylecgonine.

Development of a 13-locus PCR multiplex system for paternity testing.

In this study the development of a 13-locus multiplex-PCR system fitting the updated demands for paternity testing in Germany is described. For this purpose an existing multiplex PCR system that allows the simultaneous amplification of eight different STR loci together with the sex-specific locus amelogenin ( genRESMPX-2, Serac, Germany) was extended. Whereas some of the primers were taken from the underlying multiplex system, suitable primer sequences were chosen for the STR loci D19S433, TPOX, TH01, D16S539, D5S818, D2S1338 and FGA. Primers of loci resulting in potentially overlapping fragment sizes were labelled with the fluorescent dyes 6-FAM, JOE and NED. Reaction conditions, such as annealing temperature, concentrations of primers and polymerase or buffer conditions were optimised to obtain a robust amplification and reproducible genotype analysis for various sample sources. Full DNA profiles from single source samples were reliably typed from template DNA amounts of as low as 120 pg, suggesting a potential use of this system also in forensic casework analysis. With a mean exclusion chance (MEC) of 99.9989% and a power of discrimination (P(D)) of about 1x10(14) (Caucasians), the new multiplex PCR system provides a significant and sensitive system for forensic DNA analysis. On the basis of these studies, a commercial kit system is now provided by Serac (Bad Homburg, Germany, genRESMPX-3).

Sudden death due to a haemoglobin variant.

A previous healthy 35-year-old man was found dead in his truck. Shortly before death he merely complained of influenza-like symptoms. The histological examination revealed evidence of a massive accumulation of sickle cells in smaller blood vessels. After molecular genetic analysis, the preliminary diagnosis of "sickle cell disease" was finally changed to the diagnosis of a sickle cell trait. It is presumed that an epileptic attack which also has to be considered as a concurring cause of death, precipitated sickling of the erythrocytes and led to a fatal sickle cell crisis.

Neuronal apoptosis following human brain injury.

Neuronal apoptosis has been investigated in paraffin-embedded brain tissue from 103 individuals who had sustained blunt head injury by use of the in situ nick translation (ISNT) technique. In order to provide reliable data for a forensic wound age estimation, a quantitative morphometric analysis was performed. Apoptotic neuronal cells could be detected in a cortical contusion with a wound age of 45 min at the earliest and in the majority of the cases with postinfliction intervals up to 2 weeks, numerous ISNT-positive cells were found adjacent to the traumatically injured area. The presented data indicate that neuronal apoptosis peaks at about 1 day and persists for at least 22 weeks after blunt head injury. The time-dependent occurrence of apoptotic cells can contribute to a forensic timing of cortical contusions and complements other immunohistochemical parameters, especially in the early postinfliction interval.

Suicide by a power drill.

This is the report of a 62-year-old man who committed suicide by drilling through his anterior chest wall with an electric power drill. Death was caused by pericardial tamponade combined with bleeding into the pleural cavity. The skin lesion at the left hemithorax was similar to a bullet entrance wound.

Unusual craniocerebral injury caused by a pneumatic nail gun.

A man was found unconscious near a ladder in a house. After resuscitation he was brought to a hospital and X-rays of the skull showed that two 12-cm long nails had completely penetrated the cranial cavity. The nails were operatively removed and after treatment for 5 weeks, the patient was transferred to a rehabilitation centre with a decreasing hemiparesis on the left side and general deterioration and then, after an attempted suicide to a psychiatric hospital. The perforating cranio-cerebral injury from a pneumatic nail gun known to reach only low muzzle velocities is a very unusual finding.

Air rifle injury with an entrance through the nose: a case report and review of the literature.

A case of attempted homicide is reported where a 31-year-old woman was shot in the left nostril with a pellet from an air rifle. The projectile channel reconstruction showed penetration of the nasal septum, the maxillary and sphenoid cavities and the dura mater, with the pellet finally lodging in the anterior cranial fossa between the sinus cavernosus and the internal carotid artery. The patient was finally discharged from hospital in a good physical condition without any neurological symptoms. Although the muzzle velocity of the air rifle was within the legal limits, the present case demonstrates the potential lethality of air weapons considering the site of entrance of the pellet.