Biomedical subjects
Publications and source records attributed to G Adebahr.
A short information is presented about exogenic psychoses in connection with massive bleeding out of erosions in the mucous membrane of the stomach and it is pointed to the fact that exogenic psychoses are more frequent in such bleedings than in traumatic bleedings of similar volumes.
The functional and nutritive circulation in the lungs is connected by anastomoses between the pulmonary and bronchial arteries. The anastomoses have the structure of blocked arteries from which arteriovenous anastomoses proceed to the peribronchial plexus. The pulmonary artery is provided with a flow impulse by the anastomoses, and oxygen-containing blood is admixed with the venous blood, thus forming an "aortalization" in the lungs. By diverting the bloodstream, venous blood can reach the bronchial artery. The peculiarities of the lung circulation are important for vital reactions in the form of macro- and microembolisms. Macroembolisms prove the functionality of the system if branches of the pulmonary artery are closed before the arteries are blocked. A hemorrhagic infarction either arises or does not arise, and the hemorrhagic infarction cannot exceed a certain limit. A microembolism is over and above the anastomoses. If the microembolism is greater, pressure in the arteria pulmonaris can cause blood from the pulmonary artery to overflow into the bronchial artery. Because arteriovenous anastomoses arise from the blocked arteries, microemboli can now reach the systemic circulation. Thus, the system described can explain the passage of microemboli into the systemic circulation, avoiding the capillaries of the lungs; on the other hand, larger microembolisms can prove the functionality of the system.
The importance is demonstrated of anastomoses between the pulmonary artery and the bronchial artery as well as of the arteriovenous anastomoses that arise from these in microembolism. In cases of air embolism, microembolism in the lungs is seldom. Therefore, there must be particular circumstances that make it possible for little air bubbles to pass the anastomoses from the pulmonary artery via the bronchial artery and the arteriovenous anastomoses into the bronchial vein. The pressure in the bronchial artery must decrease. Under these conditions, blood is shunted from the pulmonary artery to the bronchial artery and little air bubbles can pass via the above-mentioned anastomoses into the pulmonary vein.
A case report is given on lethal perforation of the right ventricle during emergency implantation of a pacemaker probe. The forensic autopsy revealed extensive lipomatous infiltration of the right ventricle in the rupture area. Lethal complications occur occasionally in spite of the standardization of implantation techniques, especially as a result of reanimation attempts. Such cases are discussed with regard to the forensic aspects with reference to the literature. Lipomatosis cordis as "locus minoris resistentiae" has special significance for ventricular perforation.
A few cases of skull and brain stab wounds are described and the clinicodiagnostic problems discussed. The injuries often remain unrecognized because the external wound often appears harmless, there are no neurological symptoms, or the clinical picture is interpreted as drunkenness, blunt injury or as another disease. The importance of a precise physical examination of the whole patient's head is pointed out. The refined methods used in modern radiodiagnostics of the skull are the most helpful in correctly recognizing these injuries; there are reports of patients with severe injuries who recovered when the correct diagnosis had been established.
Two cases are reported of unexpected and unclarified death caused by an infection with Entamoeba histolytica. The first case concerned a German whose disease was not diagnosed during the asymptomatic phase (2 years' duration) or in the acute phase during the last 3 weeks before death. This is typical of the disease. In the final phase, he developed a hepatic abscess. Death occurred as a consequence of bilateral apoplexia in the adrenal glands. In the second case a Turk fell ill with gastralgia and diarrhea. Developing hepatic insufficiency with comsumptive coagulopathy, he died after 6 days. Intoxication and/or intolerance of fructose were assumed as tentative diagnoses. These two cases show clearly that even outside an endemic area, one has to reckon with the possibility of amebiasis.
The different aspects of brain death are discussed. It is pointed out that the diagnosis of poisoning as the cause of brain death can be checked by toxicological examination of brain tissue and of blood in the sinus of the dura mater, since the metabolism in the brain and sinus blood is markedly reduced while drugs and toxic substances continue to be broken down in the other organs. Particular importance attaches to this difference in the case of crimes of violence creating conditions that predispose to brain death when the significance of a further violent act, e.g. stabbing with resultant haemorrhage, has to be assessed. The simple vital reaction of bleeding does not of itself constitute proof in such a situation, unless it is possible to say with a good degree of certainty that brain death did not occur at the moment when the victim was stabbed. It may, however, be possible to state that brain death that could have been caused by violence has not yet occurred if complex vital reactions, such as inflammation of a wound, are seen.
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The respirator lung is characterized histologically in the first exudative phase by capillary congestion, intra-alveolary edema, hyaline membranes and in most cases by concomitant inflammatory alterations. In the following irreversible phase, fibrous organization processes dominate and show a variable tendency towards pulmonary fibrosis. In 27 cases with long-term artificial respiration from 4 days to 12 weeks, mainly the proliferative alterations were investigated. In 18 cases, the histopathological findings indicated fibrosis of the alveolar septa with disseminated distribution. In 9 cases, focal fibrosis with obliterations of alveoli prevailed. The extent of pathological results in the lungs does not correlate with the duration of artificial respiration. In cases of artificial respiration with pure oxygen, there is a special toxic component, which is illustrated by a young woman with polytraumatism who was administered artificial respiration for 5 weeks with pure oxygen. She died from respiratory insufficiency with severe pulmonary fibrosis. As different pathogenetic factors may cause irreversible pulmonary fibrosis, histomorphological classification is difficult later and, moreover, forensic problems result.
Interstitial emphysema and pulmonic hemorrhage alone are not the causes of pulmonic air embolism. The conditions making the entrance of air from the lungs to the vessels of pulmonary circulation are obviously present only if the expiration pressure is suddenly strongly elevated. Based on this point of view, investigations were performed in autopsy cases--falls from a height, being run over, a gunshot in the abdomen. We have succeeded in proving the entrance of air into capillaries and branches of the pulmonary vein. The precipitation of thrombocytes at the margin of large air bubbles in pulmonary veins shows the finding of air in the vessels as a vital or supravital reaction.
A fat embolism is seldom seen in the spleen. In some cases, fat globules lie in the central arteries and capillaries of the Malpighian bodies only and in other cases in the red pulp in capillaries or sinus. Part of the fat droplets has been phagocytosed by mononuclear cells, especially when patients die some days after injury and the beginning of fat embolism in the systemic circulation. The distribution of fat emboli described can been explained by the peculiarities of vascular structures in form of sheathed capillaries, which arise from pencil arterioles and probably do not permit fat globules to pass the capillary wall in this part of the vasculature.
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A case of fetal alcohol syndrome is described, in which supernumerary corpora mamillaria were found and in which the exterior embryonal-cell granular layer of the cerebellum showed superficial indentations.
A man 61 years of age had fallen ill 4 years before he died. He suffered from hypertension and from pseudobulbar palsy. While he was eating he suddenly died. The cause of death was asphyxia by an alimentary bolus. No influence of alcohol and/or drugs was found. There were several malformations in the brain: absence of corpus callosum, heterotopias and porencephaly. The death is regarded as connected with these malformations.
Histomorphological demonstration of an air embolism in the blood of the right chamber of the heart can be altered as a result of the influence of barbiturates, during reanimation, the cause of which is an air embolism in the pulmonary circulation or in injuries to the lungs.
In choking, throttling, and atypical hanging lymph nodes above and below the region of violence show dilatation and hyperemia of capillaries, unequally distributed. Moreover, irregularly distributed slight bleedings in the tissue of lymph nodes are to be found. Blood is to be seen in the intermediary sinuses and in the marginal sinus in spite of the short time of survival. Obviously, the intensity of violence is of importance. Hypostasis in a deep position of head during unconsciousness and reanimation procedures--both events usually last one or several hours--produce an almost equal dilatation of capillaries and veins of cervical lymph nodes. Slight bleedings are to be found especially near the follicles. The different microscopic pictures may be of significance with regard to differential diagnosis.
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