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Biomedical subjects

E Rauch

Publications and source records attributed to E Rauch.

At least 19 recordsLinked to original sources
PubMed2007

[Self-mutilation from a forensic medicine viewpoint].

The frequency of the diagnosis of self-induced injuries is rising, especially in patients with borderline personality disorder. The number of unreported cases is estimated to be high. Self-mutilation typically affects the patient's skin and therefore often presents to dermatologists or general practitioners. Such injuries are often clinically typical; a knowledge of these features is essential for the correct diagnosis and treatment. Multidisciplinary care is essential because of the tendency for overlap with other psychiatric diseases and the risk of suicide. Self-induced injuries are also used to simulate criminal offences and to fraudulently obtain insurance payments. In these cases appropriate diagnosis is important from both a legal and psychiatric point of view. Typical morphological aspects and combination of clinical signs in cases of self-mutilation are presented from forensic point of view to facilitate confirming the diagnosis.

Borderline Personality Disorder↗
PubMed2006

Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform.

Sleepiness is considered to be the major cause of increased traffic accidents in patients with obstructive sleep apnoea syndrome (OSAS). Until now, OSAS patients' driving ability has been assessed using driving simulators, but no assessment in a more natural driving environment has been carried out to date. The aim of the present study was to evaluate driving parameters in OSAS and in controls on a road safety platform, and to compare them with attentional in-laboratory measures before and after continuous positive airway pressure treatment. The parameters measured were: reaction time; distance to stop and number of collisions on the platform; maintenance of wakefulness; and sustained, selective and divided attention in laboratory. Patients exhibited much longer reaction times than controls, leading to a lengthening of the vehicle's stopping distance of 8.8 m at 40 km.h(-1) and to twice the number of collisions. Patients did not demonstrate objective sleepiness or selective and sustained attention deficits. Divided attention deficits were found. However, they did not allow the prediction of real driving impairment. After CPAP treatment, there was no longer any difference between patients and controls regarding driving and attention performances. Driving abilities are significantly impaired in obstructive sleep apnoea syndrome. After continuous positive airway pressure treatment, deficits were normalised. This stresses the importance of evaluating attentional parameters in apnoeic patients and of offering continuous positive airway pressure treatment even to non-sleepy subjects.

Attention↗
PubMed2006

[Typical findings of maltreated children].

Childhood maltreatment manifests in a variety of forms and the underlying causes are manifold. In contrast to other offences involving physical injury, reporting behavior has, statistically speaking, remained unchanged. Patterns of injury must first be established and documented, and this involves a complete examination of the child's body. Depending on the constellation of findings, a radiological diagnosis is usually necessary. When all the findings have been collected, the further steps to be taken--where indicated a report to the police--must be discussed. All the evidence must be recorded, and photos obtained of all externally visible injuries before they fade. It is not the task of the physician to develop criminalistic ambitions, for example, by grilling (a parent) on the cause of the injuries. However, he/she has a duty to do everything necessary to protect the well-being of the child.

Child↗
PubMed2005

Unnatural causes of sudden unexpected deaths initially thought to be sudden infant death syndrome.

The aim of this clinicopathological study was to determine the frequency of infant deaths due to unnatural causes among cases of sudden and unexpected infant death. Nine institutes of legal medicine in Germany that took part in the German study on Sudden Infant Death Syndrome (GeSID), representing 35% of the German territory, investigated in a 3-year period (from 1998 to 2001) 339 cases of infant death that were not expected to be due to unnatural causes from the first external examination. All cases were investigated by complete, standardised, post-mortem examination including death scene investigation, autopsy, histology, toxicology and neuropathology. The frequency of unnatural deaths was 5.0% (n=17). The causes of death were head injury (n=7), suffocation (n=5), poisoning (n=2), neglect (n=2) and septicaemia due to aspiration of a foreign body (n=1). Two deaths were unsuspected accidents and 12 were due to infanticide. In 3 cases, it was not possible to differentiate between accidental death and infanticide. A complete postmortem examination including an analysis of the clinical history, death scene investigation, autopsy, histology, toxicology, and neuropathology is mandatory to differentiate sudden and unexpected deaths due to natural causes (e.g. SIDS) and cases of unnatural death.

Autopsy↗
PubMed2005

High-resolution diffusion tensor imaging of human patellar cartilage: feasibility and preliminary findings.

MR diffusion tensor imaging (DTI) was used to analyze the microstructural properties of articular cartilage. Human patellar cartilage-on-bone samples were imaged at 9.4T using a diffusion-weighted SE sequence (12 gradient directions, resolution = 39 x 78 x 1500 microm(3)). Voxel-based maps of the mean diffusivity, fractional anisotropy (FA), and eigenvectors were calculated. The mean diffusivity decreased from the surface (1.45 x 10(-3) mm(2)/s) to the tide mark (0.68 x 10(-3) mm(2)/s). The FA was low (0.04-0.28) and had local maxima near the surface and in the portion of the cartilage corresponding to the radial layer. The eigenvector corresponding to the largest eigenvalue showed a distinct zonal pattern, being oriented tangentially and radially in the upper and lower portions of the cartilage, respectively. The findings correspond to current scanning electron microscopy (SEM) data on the zonal architecture of cartilage. The eigenvector maps appear to reflect the alignment of the collagenous fibers in cartilage. In view of current efforts to develop and evaluate structure-modifying therapeutic approaches in osteoarthritis (OA), DTI may offer a tool to assess the structural properties of cartilage.

Anisotropy↗
PubMed2002

Stability and instability of polymorphic populations and the role of multiple breeding seasons in phase III of Wright's shifting balance theory.

It is generally difficult for a large population at a fitness peak to acquire the genotypes of a higher peak, because the intermediates produced by allelic recombination between types at different peaks are of lower fitness. In his shifting-balance theory, Wright proposed that fitter genotypes could, however, become fixed in small isolated demes by means of random genetic fluctuations. These demes would then try to spread their genome to nearby demes by migration of their individuals. The resulting polymorphism, the coexistence of individuals with different genotypes, would give the invaded demes a chance to move up to a higher fitness peak. This last step of the process, namely, the invasion of lower fitness demes by higher fitness genotypes, is known as phase III of Wright's theory. Here we study the invasion process from the point of view of the stability of polymorphic populations. Invasion occurs when the polymorphic equilibrium, established at low migration rates, becomes unstable. We show that the instability threshold depends sensitively on the average number of breeding seasons of individuals. Iteroparous species (with many breeding seasons) have lower thresholds than semelparous species (with a single breeding season). By studying a particular simple model, we are able to provide analytical estimates of the migration threshold as a function of the number of breeding seasons. Once the threshold is crossed and polymorphism becomes unstable, any imbalance between the different demes is sufficient for invasion to occur. The outcome of the invasion, however, depends on many parameters, not only on fitness. Differences in fitness, site capacities, relative migration rates, and initial conditions, all contribute to determine which genotype invades successfully. Contrary to the original perspective of Wright's theory for continuous fitness improvement, our results show that both upgrading to higher fitness peaks and downgrading to lower peaks are possible.

Algorithms↗
PubMed2000

Evaluation of the ICT malaria Pf test for rapid post-mortem diagnosis of Plasmodium falciparum malaria in corpses examined for forensic reasons.

To test the diagnostic value of a rapid and simple immunochromatographic test (ICT) based on the detection of Plasmodium falciparum histidine-rich protein 2 (PfHRP2) for post-mortem examination, blood samples from 30 consecutive corpses were analysed by ICT and Giemsa-stained blood films. Compared to microscopy, ICT had 100% sensitivity and 100% specificity even after a considerable time had passed between the presumed time of death and testing or after prolonged storage of whole blood samples. The ICT yielded positive results for four travellers who had returned from Kenya and died from Pl. falciparum malaria. The ICT might therefore serve as an additional tool for rapid malaria diagnosis, especially in non-endemic countries where experience with microscopic malaria detection is limited.

Adult↗
PubMed2000

An allelic variation in the human prodynorphin gene promoter alters stimulus-induced expression.

Prodynorphin, the precursor of the dynorphin opioid peptides, has been shown to play an important role in several aspects of human diseases and complex traits, e.g., drug abuse, epilepsy, and mood disorders. The objective of this study was to identify polymorphisms in the 5' control region of the human prodynorphin gene and to relate these polymorphisms to prodynorphin gene expression. Within the core promoter region, a 68-bp sequence was found to occur as a polymorphic element, either singular or as tandemly repeated element two, three, or four times. This 68-bp repeat element contains an AP-1 transcription factor binding site as demonstrated by electrophoretic mobility shift assay. Reporter gene assays were performed and provided evidence for allele dependent different promoter activity. Dynorphin was found to be involved in many pathophysiological processes so that the described prodynorphin alleles may correlate with the occurrence of several diseases, for example, drug addiction. However, prodynorphin allelic distributions were not significantly different in heroin addicts and control subjects.

Alleles↗
PubMed2000

A retrospective study on perfusion incidents and safety devices.

Despite the acceptance of extracorporeal circulation as an effective modality to facilitate cardiac surgery, patient outcomes can be negatively influenced by the occurrence of perfusion incidents. A perfusion survey was conducted to identify safety techniques and incidents related to cardiopulmonary bypass (CPB). An 80-question survey was mailed to chief perfusionists of all 1030 USA cardiac surgical centers using CPB. The survey was designed to examine practices and incidents that occurred during a 2-year period (July 1996 to July 1998). Five-hundred-and-fifty-two (54% response rate) surveys were returned, which accounted for 797 hospitals (79% of all cardiac centers) and 653,621 surgical procedures. Of the 27 identified CPB safety devices, the highest utilization was arterial line filters (98.5%) and the lowest arterial line bubble traps (3.4%). Of the reported cases, a CPB incident occurred once every 138 cases. The most common occurring incidents were protamine reactions (1:783), coagulation problems (1:771), and heater/cooler failures 11:1809). The rate of occurrence of an incident resulting in a serious injury or death was one for every 1453 procedures. Although techniques and safety devices create a relatively secure environment for CPB, lower incident rates may be achieved with further improvements in coagulation monitoring and incident reporting.

Equipment Safety↗
PubMed1999

Distribution of herpes simplex virus type 1 in human geniculate and vestibular ganglia: implications for vestibular neuritis.

Vestibular neuritis is a common cause of partial unilateral vestibular paralysis, which usually spares posterior semicircular canal function. The cause is assumed to be a viral reactivation of latent herpes simplex virus type 1 (HSV-1) in human vestibular ganglia. The existence of an anastomosis between the intermediate nerve and the superior vestibular nerve suggests the question of whether selective affliction of the superior vestibular nerve is the result of migration of HSV-1 from the geniculate ganglion along this faciovestibular anastomosis. We determined the distribution of HSV-1 among geniculate ganglia, vestibular ganglia, and within Scarpa's ganglion by examining 35 human temporal bones by polymerase chain reaction. HSV-1 was found in 66% of geniculate ganglia and 60% of vestibular ganglia; all examined parts of vestibular ganglia were almost equally HSV-1 infected. Our data provided no support for viral migration along this anastomosis or for a preferential latency of HSV-1 in the superior vestibular nerve. We suggest that the common double innervation of the posterior ampulla by two nerves running in two separate bony canals could offer an alternative explanation for the regular sparing of posterior canal function in vestibular neuritis.

Adolescent↗
PubMed1999

The effect of hydrosalpinges on IVF-ET outcome.

PURPOSE: Our purpose was to determine if the presence of a hydrosalpinx effects the outcome of in vitro fertilization (IVF)-embryo transfer. METHODS: We performed a retrospective analysis of IVF cycle stimulation sheets. RESULTS: A total of 1000 patients with tubal factor infertility was analyzed. There were 60 hydrosalpinx patients who underwent 116 initiated cycles with 106 embryo transfers, compared to 940 control patients undergoing 1428 initiated cycles with 1150 embryo transfers. Both groups had a similar response to ovarian stimulation, number of oocytes retrieved, and number of embryos transferred. The hydrosalpinx group had a significantly higher preclinical loss rate (22/59 = 37% vs 80/566 = 14%; P = 0.001), a significantly lower implantation rate (55/352 = 16% vs 795/3795 = 21%; P = 0.013), a trend toward a reduced delivery rate per transfer (28/106 = 26% vs 387/1150 = 34%; P = 0.066), a significantly higher ectopic pregnancy rate (5/59 = 8% vs 16/566 = 3%; P = 0.04), and a similar spontaneous abortion rate (9/37 = 24% vs 99/486 = 20%; P = 0.28) compared to the control tubal factor group. CONCLUSIONS: This study demonstrates a decrease in implantation rates and an increase in preclinical miscarriages and ectopic pregnancies in patients with hydrosalpinges compared to tubal-factor patients without sonographic evidence of dilated fallopian tubes.

Abortion, Spontaneous↗
PubMed1998

Highly variable distribution of HSV-1-specific DNA in human geniculate, vestibular and spiral ganglia.

Viral reactivation in temporal ganglia is the suspected cause of Bell's palsy, vestibular neuritis and sudden hearing loss. Since the distribution of latent herpes simplex type 1 (HSV-1) in geniculate, vestibular and spiral ganglia of individual human temporal bones could have implications for the explanation of isolated as well as combined disorders of these three cranial nerves, we examined these ganglia in 18 human temporal bones of adults by nested polymerase chain reaction. In all of the temporal bones HSV-1 specific DNA was detected: 10/18 (56%) of the geniculate, 11/18 (61%) of the vestibular and 9/18 (50%) of the spiral ganglia samples were positive. All combinations of positive and negative ganglia were found in individual temporal bones at roughly equal frequencies. These data support a viral etiology of all three conditions, especially their occasional combinations.

Adult↗
PubMed1997

Association between a delta opioid receptor gene polymorphism and heroin dependence in man.

Two allelic variants of the delta opioid receptor gene, distinguished by a single base exchange T to C in codon 307 of the translated region, were detected in humans. The amino acid sequence was thereby not changed. The resulting C and T alleles combined to give the three genotypes CC, CT and TT. Allele C was more frequent in a sample of 103 German Caucasian heroin addicts (53.4%) than in a control group (39.1%, n = 115). The proportion of CC homozygotes was much greater among the drug-dependent subjects (26.2%) than in controls (9.6%). Although the reasons for this association remain to be explained, our results argue for a participation of the delta type of opioid receptors in the pathophysiology of heroin dependence.

Alleles↗
PubMed1997

Effects of toluidine blue and destaining reagents used in sexual assault examinations on the ability to obtain DNA profiles from postcoital vaginal swabs.

Toluidine blue is an important tool to detect and document genital and perianal injuries following sexual assault. Application of toluidine blue dye and its subsequent removal from unstained areas by means of a destaining reagent, such as diluted acetic acid or a lubricant has been shown to increase the detection rate of posterior fourchette lacerations from 16% to 40% in adult rape victims. Currently, limited information on toluidine blue positive findings in sexually active control groups imposes some limitation on the interpretation of these injuries. Because injuries could otherwise be attributed to improper handling of an examination speculum or the improper insertion of the examining finger, the toluidine blue test should be performed prior to any digital or speculum examination and thus prior to the collection of forensic evidence. For forensic DNA identity testing, it becomes pertinent to determine whether toluidine blue and the destaining reagents used in a sexual assault examination have an adverse effect on the recovery of high molecular weight DNA from postcoital vaginal swabs and thereby have an impact on restriction fragment length polymorphism (RFLP) analysis or PCR-based tests. It is known that some of the lubricants used can have a destructive effect on sperm motility. In order to investigate the potential effects, postcoital vaginal swabs were taken 6 h after sexual intercourse and exposed directly to 1% toluidine blue in aqueous solution, 1-10% acetic acid, and various surgical and vaginal lubricants. Subsequently, the DNA was isolated and DNA identity typing (RFLP and PCR-based) was performed. The results demonstrate, that these reagents have no negative effect on the ability to obtain DNA profiles, either RFLP or PCR-based, from shallow and deep vaginal swabs. The quantity and quality of extractable high molecular weight DNA obtained was comparable with that from uncontaminated postcoital vaginal swabs. RFLP patterns and PCR-based typing results on the D1S80, HUMTH01, TPOX, and CSF1PO loci were consistent with the uncontaminated control swabs and the corresponding whole blood samples of the donors. Therefore, evidentiary material inadvertently contaminated with these reagents can be successfully typed.

Adult↗
PubMed1996

Aortic endothelium in HIV-1 infection: chronic injury, activation, and increased leukocyte adherence.

Clinical and serological studies provide evidence for a pathogenetically relevant vasculopathy in acquired immune deficiency syndrome (AIDS); however, the morphological status of the endothelium under conditions of human immunodeficiency virus (HIV)-1 infection is only sparsely documented. In this study we adapted an en face preparation technique of endothelium for use in immunohistochemistry and investigated the aortic endothelium of pre-AIDS and AIDS patients (n = 32) in comparison with an HIV-negative group (n = 17). The control group showed a regular pattern of evenly distributed aortic endothelial cells, whereas the endothelial cell pattern in the HIV-1-infected patients was clearly disturbed. Simultaneously, the degree of leukocyte adherence on the aortic endothelium increased significantly. These changes were accompanied by an up-regulation of the vascular cell adhesion molecule-1 (VCAM-1) and E-selectin (ELAM-1). The endothelium turnover increased, and one-half of the HIV-1-infected patients exhibited HLA-DR (major histocompatibility complex class II) antigen in the aortic endothelium. Our results provide evidence for a profound and repeated injury with regeneration and activation of the endothelium in HIV-1 infection. Injury as well as activation of the endothelium impairs its normal regulatory properties. This could have consequences for the maintenance of the blood-brain barrier; it might influence the immunologically important interaction of the endothelium with T cells; and it might trigger Kaposi's sarcoma.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Towards productive Knowledge-Based Systems in clinical organizations: a methods perspective.

This paper discusses an approach towards Knowledge-Based Systems (KBS) development which emphazises fit in the clinical organization, utility and safety. KBS design is identified as a subset of Decision Support System (DSS) design, and experiences from use of development methods is made available from the more general field. Generic and specific issues related to making KBS development result in systems used in clinical practice are discussed, and an integration of the Logic Engineering KBS technique into the Action Design DSS requirements specification method is outlined. Group-based knowledge modeling is identified as the bridge between the methods. It is concluded that while Action Design provides organizational validation (Are we building the right system?), Logic Engineering adds on KBS design verification (Are we going to build the system right?).

Artificial Intelligence↗
PubMed1990

[Fatal complications in endoscopic papillotomy].

Medicolegal investigations for possible malpractice were instituted into the death of three patients (two women, aged 59 and 75 years, one man, aged 81 years) after endoscopic papillotomy. In one case the accusation of malpractice had been made by a relative, in the other two the enquiry had been undertaken because the attending doctors had entered the cause of death as "unexplained" on the death certificate. In one patient oesophageal rupture had occurred; in the other two papillary bleeding, with perforation in one, had taken place. Forensic expert opinion failed to find malpractice as the cause of death. There had been the correct indications for the procedure and the patients had been fully informed. Taking into consideration the possible complications of this procedure, it is important to note that insufficient explanations and inadequate experience of the doctor, as well as insufficient capacity for undertaking an emergency operation, may lead to damages being awarded, especially under civil law.

Aged↗