Biomedical subjects
Publications and source records attributed to D Metter.
Diabetes mellitus affects approximately 5% of the population in the United States. In the United States alone, as many as 50,000 amputations are performed each year for vascular insufficiency or osteomyelitis in diabetic patients. In each case, foot disease is multifactorial.
The diagnosis of renal artery embolism should be considered in patients with cardiac disease who present with abdominal or flank pain in association with deteriorating renal function. Often the diagnosis is delayed or missed owing to the nonspecific, varied, and protean clinical manifestations. A case is presented of bilateral renal artery emboli, and initial and long-term scintigraphic and radiographic correlations are provided. Renal scintigraphy should be the initial study of choice. In addition, this procedure allows for sequential noninvasive evaluation of renal function.
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39 deaths, in which medical malpractice was suspected and forensic autopsy therefore was carried through, were examinated. Among 22 cases with manifest malpractice not sufficient diagnosis, not adequate anamnesis and mistakes related with surgical treatment are dominant. If any deciding factors refer to medical malpractice, a specialists opinion of the respective discipline should be taken together with medicolegal opinion. In such cases it proved to be useful, when medicolegal expert has a coordinating function.
The development of the HIV-1-prevalence among drug deaths (n = 753) in several German cities (West Berlin, Frankfurt, Munich, Hamburg, Bremen, Cologne and Stuttgart) from 1985 to 1988 was evaluated; in 1988 43% of 674 deceased drug addicts were examined. The regional prevalence rate was between 15 and 25%; only in Berlin 42% of the drug deaths were HIV-infected (cumulated data of all cities over the 4-year-period: 26%). There was no uniform or steady regional development of HIV-1-prevalence in the different cities. The ratio men/women among drug deaths was 3:1. The HIV-1-prevalence among males was 22%, among females 40%. HIV-infected individuals were 2-3 years older than seronegatives. Predictions concerning the trend of prevalence rates are not possible up to now. Continuous monitoring of the HIV-status of drug deaths seems to be a worthful method to evaluate the spread of this disease among the risk group of intravenous drug addicts.
101 homicides caused by stabbing were examined for the presence of defence-injuries. 50 victims showed 174 defence-injuries on hands and forearms (133 incision wounds, 26 stab wounds and 15 cutting through). More than two thirds of lesions were found on left arm. That those lesions mostly were found on left arm is caused by the interaction between perpetrator and victim. Victims left arm is nearest to the perpetrator therefore it is used as a mean of defence first of all. The probability that defence-injuries can be seen is rising with the number of stab wounds. Localisation of a defence-injury on the extensor side ("passive") or on the flexor side ("active") is conditioned by accidentalities. Such a differentiation should be given up because no conclusions on the readiness of defence can be drawn.
Hypoglycemia is the most important subsidiary effect of insulin therapy, where traffic medicine is concerned. A study has been made of 8 motor car drivers each dependent on insulin and involved in road accidents. The evidence was issued during the trial. The questions set out to prove if there was a state of hypoglycemia and if the afflicted could have foreseen this condition. In 5 cases the driving conduct before the accidents was evident in cordinatory disturbances, which resulted in sinuous driving. The accidents all happened in every-day traffic conditions, namely counter traffic (3), front-end collision (3) and through disregard of right-of-way at cross-roads (1). A further accident was conditioned by an alcoholic state while parking in a car-park. The disturbances in consciousness conditioned by hypoglycemia occurred without warning. In 3 cases the predictability (in legal terms Actio libera in causa) had to be conceded, because the drivers had set out on their routes despite warning signals or insufficient intake of nourishment beforehand.
14 X-ray examined deaths caused by cranial bullet injuries are described. Three of them are demonstrated. In all cases with bullet injuries X-ray examination should be done prior to the post mortem. With radiographs bullets can be localised quickly. An antero-posterior and a lateral view are necessary. Little parts of the bullet and bone meal particles may be visible in radiographs along the path of the bullet; using normal technique of autopsy those details may not be visible.
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A case of latent tetany in a 24-year-old woman is reported. She had suffered several attacks of tetany in the last 12 years, mostly triggered by external stimuli. One evening, the woman was found dead in the hall of her flat beside the telephone with the upper limbs in a tetanic convulsive attitude. The attack of tetany was triggered by a telephone conversation. The parathyroid glands were normal. Day-old purulent myocarditis could be demonstrated in the left ventricle under the light microscope. The two possible pathogenetic explanations of the causal chain leading to death are discussed. It was astonishing that a clinical symptom (tetanic convulsion) was fixed in rigor mortis.
The alterations in the hair roots discovered by Widy in 1956 were interpreted as accumulations of pigment which form as a consequence of a catalytic action of the poison. The goal of the present investigation was to clarify the structure of these inclusions. Hair from the heads of six victims who were involved in the poisoning of Würzburg medical students in January 1983 was available as investigation material. In the investigation in transmitted light and in polarized light, the black zones typical for thallium intoxication were found filling to varying extents the root and hair shaft near the root. Their intensity corresponded to the degree of severity of the intoxication. When examined under reflected light, the inclusions were shown up with a white color. They thus showed the same optical behavior as the air-filled medullary strand of normal hairs. This indicates that gaseous constituents are involved. This hypothesis could be confirmed by further investigations. After mechanical damage to the hair (pressing under high pressure), the gaseous inclusions disappeared and with them the "thallium strip." The same effect was attained by the chemical action of various acids, embedding agents, and dye solutions. This process was especially rapid after exposure to thioglycolic acid; the escape of the gas bubbles can be directly observed here. Scanning electron microscopic investigations on transverse sections of hair revealed a loosening of the spindle-shaped elements of the fiber layer as signs of structural disturbance. The gaseous constituents in thallium hair arise as the result of a trophic disorder in keratin formation. The structural alteration due to this leads to alopecia.
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Investigations of clues in 87 fatal pedestrian-car accidents which took place with erect posture of the body are reported. Traces of paint proved to be most important clues transferred from the vehicle to the pedestrian's clothing. They derived from the outer paint layer of the collision sites at the front of the vehicle and occurred in 49% of the cases investigated. As has been shown by light and scanning electron microscopic investigations, there is intensive contact between the textile fibers and the paint traces which can be explained by action of heat in the collision. The higher the collision speed, the more readily paint is rubbed off. Because traces of rubbed off paint mark the site of the vehicle impact and indicate the color of the vehicle, they have a high evidence value for reconstruction of the accident. This also applies to traces of molten plastic material as well as to rubbed off chrome and rubber. In contrast to the prevalent view, paint splitters are unsuitable for determining the impact direction. Textile microtraces, traces of blood, hair and tissue occur as transferred clues from the pedestrian to the vehicle. These clues do not permit any statements with regard to the impact direction. They must be evaluated in connection with the remaining clues and the injuries.
Stellate wounds are to be expected in gunshot injuries to the liver and spleen. As to their configuration, they resemble the skin breaks in an absolute close-range shot. The exit wound is larger than the entry wound. The genesis and utility of such injuries for reconstruction of the shot direction are discussed with reference to seven gunshot mortalities. Stellate wounds could also be achieved by shooting at isolated cadaver organs. The experimentally produced gunshot wounds differed from those produced in vivo in that the entry and exit wounds were equally large.