RESUMO
BACKGROUND: Despite the benefit of safety vests to the reduction of torso injuries in children and adolescents is unclear, its' use is recommended. The aim of the present study is to determine the effectiveness of safety vests actually used in pediatric equestrian activities. PATIENTS AND METHOD: In this case-control-study, we analyzed the accidents of 92 riders aged 18 or younger who fell off a horse onto his/her torso during a period of 18 months. Data were gathered from the clinical records. Additionally, a questionnaire was administered on the day of trauma by the patients and/or their parents. RESULTS: The cases comprised 31 patients who sustained torso injuries. The controls were 61 riders with injuries of other body parts than to the torso. Safety vest use was not associated with a lower risk of torso injuries (OR=1.18, 95% CI (0.50, 2.81), p=0.707). Post hoc power analysis revealed that within such a setting an odds ratio of 0.266 could be found with a power of 80%. CONCLUSION: This study is not able to show an association between wearing a torso protector and protection from torso injuries, probably due to confounding. We did not detect a high effect of safety vest usage in our study population. Whether the development of a new generation of safety vests might be more effective remains unclear. An effective vest should be adapted to the requirements of children and adolescents and should protect the thorax and abdomen, but also the cervical and the lumbar spine.
Assuntos
Acidentes por Quedas , Traumatismos em Atletas/prevenção & controle , Cavalos , Roupa de Proteção , Tronco/lesões , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Animais , Traumatismos em Atletas/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Desenho de Equipamento , Extremidades/lesões , Feminino , Humanos , Modelos Logísticos , Masculino , Traumatismo Múltiplo/epidemiologia , Traumatismo Múltiplo/prevenção & controle , Análise MultivariadaAssuntos
Determinação da Idade pelo Esqueleto , Determinação da Idade pelos Dentes , Literatura Erótica/legislação & jurisprudência , Filmes Cinematográficos , Fotografação , Acne Vulgar , Adolescente , Constituição Corporal , Estatura , Mama/crescimento & desenvolvimento , Criança , Dentição Permanente , Feminino , Ciências Forenses/legislação & jurisprudência , Genitália/crescimento & desenvolvimento , Cabelo/crescimento & desenvolvimento , Humanos , Masculino , Desenvolvimento Maxilofacial , Dente Serotino , Aparelhos Ortodônticos , Puberdade , Dente DecíduoRESUMO
PURPOSE: To optimize multislice computed tomography (MSCT) protocols of the midface for dose reduction and adequate image quality. MATERIALS AND METHODS: MSCT (Somatom Volume Zoom, Siemens) of the midface was performed on 3 cadavers within 24 hours of death with successive reduction of the tube current, applying 150, 100, 70 and 30 mAs at 120 kV as well as 40 and 21 mAs at 80 kV. At 120 kV, a pitch of 0.875 and collimation of 4x1 mm were used, and at 80 kV, a pitch of 0.7 and collimation of 2x0.5 mm. Images were reconstructed in transverse and coronal orientation. Qualitative image analysis was separately performed by two radiologists using a five-point scale (1 = excellent; 5 = poor) applying the following parameters: image quality, demarcation and sharpness of lamellar bone, overall image quality, and image noise (1 = minor; 5 = strong). The effective body dose [mSv] and organ dose [mSv] of the ocular lens (using the dosimetry system "WINdose") were calculated, and the interobserver agreement (kappa coefficient) was determined. RESULTS: For the evaluation of the lamellar bone, adequate sharpness, demarcation and image quality was demonstrated at 120 kV/30 mAs, and for the overall image quality and noise, 120 kV/40 mAs was acceptable. With regard to image quality, the effective body dose could be reduced from 1.89 mSv to 0.34 mSv and the organ dose of the ocular lens from 27.2 mSv to 4.8 mSv. Interobserver agreement was moderate (kappa = 0.39). CONCLUSION: Adequate image quality was achieved for MSCT protocols of the midface with 30 mAs at 120 kV, resulting in a dose reduction of 70 % in comparison to standard protocols.
Assuntos
Face/diagnóstico por imagem , Ossos Faciais/diagnóstico por imagem , Doses de Radiação , Tomografia Computadorizada Espiral/métodos , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tomografia Computadorizada Espiral/instrumentaçãoRESUMO
The total nerve cell numbers in the right and in the left human entorhinal areas have been calculated by volume estimations with the Cavalieri principle and by cell density determinations with the optical disector. Thick gallocyanin-stained serial frozen sections through the parahippocampal gyrus of 22 human subjects (10 female, 12 male) ranging from 18 to 86 years were analysed. The laminar composition of gallocyanin (Nissl)-stained sections could easily be compared with Braak's (1972, 1980) pigmentoarchitectonic study, and Braak's nomenclature of the entorhinal laminas was adopted. Cell-sparse laminae dissecantes can more clearly be distinguished in Nissl than in aldehydefuchsin preparations. These cell-poor dissecantes, lamina dissecans externa (dis-ext), lamina dissecans 1 (dis-1) and lamina dissecans 2 (dis-2), were excluded from nerve cell number determinations. An exact delineation of the entorhinal area is indispensable for any kind of quantitative investigation. We have defined the entorhinal area by the presence of pre-alpha cell clusters and the deeper layers of lamina principalis externa (pre-beta and gamma) separated from lamina principalis interna (pri) by lamina dissecans 1 (dis-1). The human entorhinal area is quantitatively characterized by a left-sided (asymmetric) higher pre-alpha cell number and an age-related nerve cell loss in pre as well as pri layers. At variance with other CNS cortical and subcortical structures, the neuronal number of the entorhinal area appears to decrease continuously from the earliest stages analysed, although a secular trend has to be considered. The asymmetry in pre-alpha cell number is discussed in the context of higher human mental capabilities, especially language.
Assuntos
Envelhecimento/fisiologia , Córtex Entorrinal/anatomia & histologia , Lateralidade Funcional , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Células , Córtex Entorrinal/citologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios/classificação , Neurônios/citologiaRESUMO
Since 1985 several European Institutes of Forensic Medicine have cooperated in a multicenter study providing a constant monitoring of HIV-1 prevalence among drug-related deaths. From 1985 to 1991 the HIV status of 5372 drug-related fatalities (4328 males, 1044 females) has been tested. A total of 764 (14%) drug deaths were HIV-positive (13% of the males, 21% of the females). In contrast to the steadily increasing number of drug-related fatalities the HIV-1 prevalence is decreasing, especially in the German cities. Regional differences are obvious. The development of the HIV prevalence of drug deaths is comparable with that of the still living intravenous drug addicts.
Assuntos
Soroprevalência de HIV , HIV-1 , Vigilância da População , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Adulto , Áustria/epidemiologia , Dinamarca/epidemiologia , Feminino , Previsões , Medicina Legal , Alemanha/epidemiologia , Soroprevalência de HIV/tendências , Humanos , Masculino , Características de Residência , Fatores de Risco , Suécia/epidemiologia , População UrbanaRESUMO
According to literature, siderophages are a characteristic histological finding in the lung of deceased drug addicts (IVDA). It was the aim of our study to evaluate their pathognomonic significance. The lungs of 591 drug deaths in Hamburg were examined histologically for siderophages in two series, with different 'Berlinerblau' (Prussian blue) staining methods. The first series (investigation period 1980-1990) showed iron-containing macrophages in 36 of 420 drug deaths (8.6%) compared with a control-group (healthy young persons dying from unnatural causes of death) in which only one was positive (2%). In a second series, using a more sensitive staining method, 80 of 171 drug deaths (47%) in the year 1991 showed siderophages, whilst in a control-group, 17 of 35 cases (49%) were positive. According to our findings the pathognomonic value of siderophages in the lung of IVDA is doubtful. There is a need for further histochemical and ultrastructural investigations concerning the morphology and etiology of pulmonary macrophages in IVDA.
Assuntos
Hemossiderina , Pulmão/patologia , Macrófagos Alveolares/patologia , Abuso de Substâncias por Via Intravenosa/patologia , Adolescente , Adulto , Estudos de Casos e Controles , Causas de Morte , Corantes , Feminino , Ferrocianetos , Medicina Legal , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/mortalidadeRESUMO
The serum myoglobin levels of 58 fatalities were investigated with special reference to correlations of the myoglobin-concentrations with the postmortem interval, the site of blood sampling and the cause of death (especially concerning death caused by electric current). An increase of the myoglobin values with the passage of postmortem time is obvious. The topographical sampling site plays an important role; the highest concentrations are found adjacent to striated muscles (i.e. in blood from the heart or the femoral vein). There was no significant correlation of myoglobin values and death by electric current.
Assuntos
Traumatismos por Eletricidade/sangue , Mioglobina/sangue , Mudanças Depois da Morte , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Since 1985, a number of Institutes of Forensic Medicine in Germany have cooperated in a multicenter study, to provide a constant monitoring of HIV-1-prevalence among drug related deaths. In 1990/91, the Institutes in Copenhagen, Stockholm, Vienna and Zürich also participated in this study. HIV-1-prevalence is decreasing in the German cities, whereas the epidemiological development is not uniform in the other major cities. Regional differences are obvious. In 1991, the prevalence rates were as follows: Berlin 15% (n = 220), Hamburg 4% (n = 179), Frankfurt 17% (n = 167), Munich 9% (n = 136), Stockholm 10% (n = 79), Copenhagen 14% (n = 130), Vienna 20% (n = 56), and Zürich 23% (n = 84).
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , HIV-1 , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Síndrome da Imunodeficiência Adquirida/etiologia , Adulto , Overdose de Drogas , Métodos Epidemiológicos , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Reprodutibilidade dos Testes , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
Deaths by fire-arms investigated at the Institute for Legal Medicine of the University of Hamburg were analyzed retrospectively since 1966. Among 70,000 deaths (33,000 autopsies) there were 838 fatalities caused by gunshots (about 30 cases per year). One third were classified as homicides, the others as suicides, only 3% as accidents. Almost the entire number of suicides was committed by men (relation male:female 20:1), whereas the proportion of women was higher among the homicides (ratio male:female 3:1). Details referring to the age of the victims, profession-coherence, alcohol-influence, capacity to act and survival-time are analyzed. The kinds of arms, and bullets (with special reference to self-made firearms), criminalistical aspects (i.e. differentiation between homicide and suicide, gun in the hand), morphological findings (i.e. nuchal and oral shots or bullet-related embolism) are introduced.
Assuntos
Causas de Morte , Homicídio/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Armas de Fogo , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-IdadeRESUMO
Because of the extreme dense accumulation of vital structures (compared with other regions of the central nervous system), in the brainstem even small lesions may cause serious clinical symptoms. Judging the forensic relevance of macroscopically visible lesions requires the knowledge of the respective possible diagnosis. As shown in three case reports (67 years, teleangiectasis; 35 years, cavernoma; 49 years, secondary hemorrhage following trauma) this demands apart from the knowledge of the normal and pathological anatomy of the brainstem always the use of histological methods.
Assuntos
Encefalopatias/patologia , Lesões Encefálicas/patologia , Neoplasias Encefálicas/patologia , Tronco Encefálico/patologia , Acidentes/legislação & jurisprudência , Adulto , Idoso , Tronco Encefálico/lesões , Hemorragia Cerebral/patologia , Diagnóstico Diferencial , Feminino , Hemangioma Cavernoso/patologia , Homicídio/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Suicídio/legislação & jurisprudência , Telangiectasia/patologiaRESUMO
The aim of our study was to gain more knowledge about the significance of acute alcoholization at the moment of death. The blood-alcohol concentrations of all sudden unexpected and nonnatural fatalities that were investigated at the Institute of Legal Medicine in Hamburg (5044 fatalities with an age below 60 years: 1177 females, 3867 males) were tested in a prospective 5-year-series (1989-1993). Measurable blood-alcohol concentrations (at least > or = 0.1 / 1000) were found in 30.2% of all deceased. Higher concentrations of > 2 / 1000 existed in 436 cases (8.6%). Alcohol prevalence and the amount of alcoholization are discussed with respect to age, sex and the manner of death (sudden natural death, accident, suicide, homicide). Alcohol as a relevant factor in sudden/unexpected death and nonnatural death seems to be underestimated. Only a small proportion of these cases are elucidated by way of routine police investigations or by the insurance companies.
Assuntos
Intoxicação Alcoólica/mortalidade , Morte Súbita/etiologia , Etanol/farmacocinética , Adulto , Intoxicação Alcoólica/sangue , Causas de Morte , Morte Súbita/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: To reduce the number of equine-related injuries, knowledge about causes of accidents is of great importance. In the present study the causes of equine-related accidents were evaluated by a questionnaire survey. Based on our results options for prevention of equine-related accidents were formulated. MATERIAL AND METHODS: The working-group "safer riding, Hamburg" and the "German riding association (FN)" created a questionnaire to evaluate causes of equine-related accidents. This questionnaire was published in the print media "Cavallo" and "St. Georg" as well as on the online portal www.hamburger-ag-reitersicherheit.de. The questionnaire was intended for all equestrians who had suffered a horse-riding accident in the past. RESULTS: 371 female and 18 male equestrians returned a completed questionnaire. At the time of the accident the average age of the casualties was 32.5 years (range: 5 - 68 years). 86 % of the casualties wore a helmet while only 14 % used a body protector. 61 % of the equestrians were amateur riders and 66 % of the accidents occurred during leisure riding. 44 % of the horses were professional sport horses. 83 % of the equestrians had known the horse for over 6 months at time of injury. DISCUSSION: The qualification of the horse as well as the familiarity between rider and horse do not seem to have an effect of reducing of the number of accidents in equestrian activities. On the other hand a good education of the rider can contribute to decrease the accident rate. While the employment of helmets in riding sports has increased in recent years the use of preventive measures such as body protectors and safety education programmes are being used too rarely.
Assuntos
Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Cavalos , Roupa de Proteção/estatística & dados numéricos , Equipamentos Esportivos/estatística & dados numéricos , Animais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , EsportesRESUMO
INTRODUCTION: Horseback riding entails several risk factors that predispose the participant to injury. Especially craniocerebral as well as spinal trauma were common reasons for severe injuries. Hence, it is important to use effective protective gear during riding activities. However, the protective effect of actual safety vests and helmets in case of accident is still unknown. In the present study reasons, mechanisms and patterns of equine-related spine injuries were analyzed. Based on these data the effectiveness of used protective gear during accident was assessed. MATERIAL AND METHODS: 30 equestrians took part in a questionnaire survey. Based on these answered questionnaires reasons, mechanisms and patterns of equine-related injuries as well as used protective gear during accident were evaluated and analyzed. RESULTS: 24 patients (80 %) were female and 6 (20 %) were male. The median age at the time of injury was 36 years (range 14 - 72 years). The causalities suffered from 18 fractures (60 %) and 11 discoligamentous injuries (37 %), in one case a bone-bruise-injury (3 %) was found. 7 equestrians (23 %) wore a safety vest at time of injury. DISCUSSION: Despite wearing a safety vest, the spine can get damaged when accident occurred. It is not possible to create vests for equestrians capable of protecting against all spine injuries in all accidents. If the energy impact is too high, serious injuries can result, even though protective body gear is worn. But the development of improved safety vests is necessary to reduce the number of severe spine injury in the future.
Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/prevenção & controle , Dispositivos de Proteção da Cabeça , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/prevenção & controle , Equipamentos Esportivos , Adolescente , Adulto , Idoso , Animais , Traumatismos em Atletas/etiologia , Feminino , Alemanha , Cavalos , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Traumatismos da Coluna Vertebral/etiologia , Adulto JovemRESUMO
INTRODUCTION: Equitation is associated with a high rate of injuries and lethal accidents. The head is the most frequently concerned body part. Hence in the majority of the cases deaths results from head injuries. In this study injuries as well as causes of deaths were analyzed in 21 cases. Actual safety standards in equitation were appraised and suggestions for improvement were formulated. MATERIAL AND METHODS: Between 1996 and 2008 21 equestrians suffered from a fatal accident in the greater area of Hamburg. In a retrospective analysis, equestrians' records which bases on the documentation of the institute of forensic medicine as well as the insurance company ARAG were reviewed. Details of the accidents were reconstructed and pattern of injuries of those wearing a riding helmet were analyzed. RESULTS: The 21 equestrians had 29 injuries. Therefrom 86 % (18 / 21) suffered from head injuries which consequences were the causes for death. In 5 cases (24 %) equestrians wore riding helmets on the date of accident. Therefrom 80 % (4 / 5) suffered from head injuries which results in death. DISCUSSION: Actual safety standards in equitation are disappointing. The implementation of the obligation wearing a helmet as well as the improvement of the efficiency of protective clothing for equestrians is essential. Prospective studies in order to broad the state of knowledge in this context are necessary.
Assuntos
Traumatismos em Atletas/mortalidade , Traumatismos em Atletas/prevenção & controle , Lesões Encefálicas/mortalidade , Lesões Encefálicas/prevenção & controle , Cavalos , Gestão da Segurança/normas , Adolescente , Adulto , Idoso , Animais , Causas de Morte , Criança , Pré-Escolar , Estudos Transversais , Feminino , Alemanha , Dispositivos de Proteção da Cabeça , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Roupa de Proteção , Adulto JovemRESUMO
This study discusses early vestibular compensation in man. Fifty-five patients suffering from acute vestibular lesions were clinically followed up over six months. More than 450 examinations were carried out, using several subtests such as observation of spontaneous, position, and positional nystagmus with Frenzel's glasses, and registrations of pendular rotation test and bilateral bithermal calories using electrooculography. The results were calculated and recorded on graphs to permit estimation of the influence of vestibular compensation on the features examined. In 71%, i.e., in 39 of the 55 patients, the side of hypoexcitability, the direction of spontaneous nystagmus, direction of preponderance, and deviation in Unterberger's stepping test changed from left to right and vice versa during compensation. It was not possible to discover a homogeneous time-course of compensation. The results have to be considered with respect to the evaluation of vestibular findings, especially in preoperative examinations to locate vestibular disturbances. The article proposes a graduated time schedule for follow-up examinations.
Assuntos
Vertigem/fisiopatologia , Doenças Vestibulares/fisiopatologia , Vestíbulo do Labirinto/fisiopatologia , Doença Aguda , Adolescente , Adulto , Idoso , Eletronistagmografia , Eletroculografia , Seguimentos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Fatores de Tempo , Testes de Função VestibularRESUMO
BACKGROUND: The aim of our study was to estimate the qualitative and quantitative influence of different blood alcohol concentrations on the results of vestibular testing. METHODS: We investigated the influence of ethanol on the results of well established neurootologic tests in 40 persons with blood alcohol concentrations of 0.0%, 0.4%, and 0.8%. RESULTS: The intensity of the vestibuloocular reflex during sinusoidal rotation was not influenced by ethanol. The directional preponderance of the nystagmic responses to the left was enlarged from 5.8% (0.0/1000) to 13.4% (0.4/1000) and to 15.5% (0.8/1000). The capability of suppressing the vestibuloocular reflex by visual fixation was reduced to 70% (0.4/1000) and, respectively, 46% (0.8/1000) of the 0.0/1000 result. The maximum speed of smooth pursuit was diminished to 84.1% (0.4/1000) and, respectively, 65.3% (0.8/1000) of the 0.0/1000 values. The pursuit movements resembled those of patients with central vestibular lesions. The latency of saccades increased from 200 ms (0.0/1000) to 220 ms (0.4 and 0.8/1000); the velocity was not changed by ethanol. At maximum target speed the gain of optokinetic nystagmus was reduced at 0.4/1000 to 66.3% and at 0.8/1000 to 51.7%, with different results to the right and the left side. CONCLUSIONS: Our results show that even slight amounts of ethanol can simulate symptoms of vestibular diseases, resulting in false diagnoses and errors in determining the therapeutic strategy.
Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Doenças Vestibulares/diagnóstico , Testes de Função Vestibular , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/sangue , Erros de Diagnóstico , Relação Dose-Resposta a Droga , Etanol/efeitos adversos , Etanol/farmacocinética , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Fisiológico/efeitos dos fármacos , Acompanhamento Ocular Uniforme/efeitos dos fármacos , Tempo de Reação/efeitos dos fármacos , Reflexo Vestíbulo-Ocular/efeitos dos fármacos , Movimentos Sacádicos/efeitos dos fármacos , Doenças Vestibulares/sangue , Doenças Vestibulares/etiologiaRESUMO
The 12,000 obductions at the Institute for Forensic Medicine of the University of Hamburg from 1981 to 1990 included 30 cases of strangulation in children up to the age of 14 years (16 females, 14 males). 7 of these cases had been accidents (during infancy), 18 children had been murdered (all age groups), 4 children (elder ones) had committed suicide. In one case it could not be decided whether the reason of death had been suicide or an accident. Summarized data concerning epidemiological, phenomenological and morphological aspects are presented. Two case histories give some hints to special aspects of accidental strangulation and homicide among children.
Assuntos
Acidentes/legislação & jurisprudência , Asfixia/mortalidade , Causas de Morte , Homicídio/legislação & jurisprudência , Suicídio/legislação & jurisprudência , Adolescente , Asfixia/patologia , Criança , Pré-Escolar , Estudos Transversais , Diagnóstico Diferencial , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pele/lesões , Pele/patologiaRESUMO
The incidental retrieval of a few, well-circumscribed, chronic multiple sclerosis plaques in a 49-year-old female who died from myocardial infarct is reported. In serial gallocyanin stained frontal sections of the brain one plaque in the left and four plaques in the right hemisphere were encountered. A total of 1.25 cm3 or 0.24% of the right hemispheric volume and a total of 0.93 cm3 or 0.2% of the left hemispheric volume was afflicted. The size as well as the topography of the plaques could explain the absence of clinical symptoms. Methodological issues concerning in vivo and post mortem diagnosis of multiple sclerosis and their impact on the epidemiology of this disease are discussed.
Assuntos
Morte Súbita Cardíaca/patologia , Esclerose Múltipla/patologia , Infarto do Miocárdio/patologia , Astrócitos/patologia , Autopsia/legislação & jurisprudência , Encéfalo/patologia , Causas de Morte , Feminino , Humanos , Macrófagos/patologia , Pessoa de Meia-Idade , Bainha de Mielina/patologiaRESUMO
The vocal ligaments insert at the anterior and posterior commissures of the larynx. These structures fulfil biomechanical functions, balancing the different elastic moduli of tendon, cartilage or bone and undergo age-related changes that may be responsible for voice changes with increasing age. The aim of this study was to analyse the insertion structures of the vocal ligaments by means of macroscopic, histological, immunohistochemical and electron-microscopic methods and to draw conclusions from age-related structural changes on a functional basis. Investigations were carried out on the larynges of 22 males and 15 females (aged 1-95 y). In adolescence, the insertion zone of the vocal ligament tendon, a dense network of connective tissue rich in sulphated glycosaminoglycans at the thyroid cartilage, is characterised by a layer between tendon and cartilage comparable to fibrocartilage. The insertion zone lacks a perichondrium. Collagen fibrils of the vocal ligament tendon penetrate directly into the thyroid cartilage. In the insertion area, the chondrocytes are surrounded by collagen fibrils, which show positive reactivity to antibodies against type I and type III collagen. Sulphated glycosaminoglycans are integrated between the collagen fibrils. In the area of the posterior glottis, elastic cartilage rests like a cap on the hyaline base of the arytenoid cartilage. There is no distinctive border between the structures. With increasing age, ossification of the laryngeal skeleton occurs, involving hyaline cartilage at the posterior glottis and hyaline and fibrocartilage at the anterior commissure. At the same time, a loss or sulphated glycosaminoglycans is observed inside the vocal ligament tendon. Advanced ossification of the laryngeal skeleton, particularly in the area of the commissures, an increasing loss of glycosaminoglycans in the vocal ligament tendon and changes in the elastic tissue reduce the elastic modulus between tendon, cartilage and bone, thus 'stiffening' the insertion zones, which could be one factor among others favouring voice changes with advancing age.