Biomedical subjects

H Maxeiner

Publications and source records attributed to H Maxeiner.

At least 37 records · Page 2Linked to original sources

PubMed1997

Detection of ruptured cerebral bridging veins at autopsy.

Subdural hematomas (SDH) are a frequent autopsy finding in victims of closed head injuries. About 2/3 of the cases in our own massive SDH series had brain contusions as a cause of bleeding. In about 1/3 of the cases, SDH resulted from ruptured vessels of the brain surface in the absence of contusions. Our experience has shown that such an "isolated" SDH may be expected in about 5% of fatal blunt head injuries. A technique is presented to detect bridging vein leakage before there is any risk of artificial damage. After sawing through the skull in the fronto-occipital plane and cutting through the upper half of the brain together with the calvarium, approximately 5-10 ml of barium sulfate are instilled into the superior sagittal sinus by a balloon catheter at low pressure, and X-rays are taken. If there is extravasation, the rupture is visible before further preparation.

Autopsy↗

PubMed1997

[Neurofibromatosis type 1 associated arteriopathy. Case report and literature review].

Reported is the case of a 36-year-old man with neurofibromatosis type 1 with lethal haemorrhage from rupture of the left common iliac artery. Histologically and immunohistochemically, no hints on angiodysplasia as a possible cause of bleeding were detected. Considering the literature and the histological findings in the area of rupture, a local weakness of the vascular wall caused by the neighbouring neurofibromatous proliferates was most probably the reason for bleeding.

Adult↗

PubMed1997

Airbag-induced lethal cervical trauma.

In a frontal collision of a car (taxicab) perpendicular into a streetcar with an impact speed of approximately 30 kph (20 mph), the driver survived with minor injuries. The front-seat passenger was extremely "out-of-position," with her seat positioned nearly fully forward. This in combination with her short stature led to fatal injuries resulting from the inflating airbag (U.S.-type) striking against her face and chin. At the scene, she was found essentially clinically dead, but was resuscitated and died finally 13 days later. Postmortem examination showed a complete disruption of all ventral ligaments between the base of the skull and the first and second vertebrae, a nearly complete ventral rupture of the medulla, and diffuse axonal injury of the brain.

Accidents, Traffic↗

PubMed1995

[Significance of pulmonary fat embolism in intra- and early postoperative fatal cases following femoral fractures of the hip region].

Between 1978 and 1994, 130 deaths after hip fractures were investigated at the Institute of Forensic Medicine of the Free University of Berlin. In this period more than 3500 such cases occurred in Berlin. Eight persons were found dead at home, 17 had conservative treatment or died before the planned operation, and 105 had an operation. Hip replacement was carried out in 49, nailing in 17, and other kinds of osteosynthesis (especially using screws) were used in 39 cases. In the surgically treated group, death occurred during the operation in 6 cases (all hip replacements), on the day of operation or the first postoperative day in 7 cases, and within the first week in 21 cases. In the conservative group 10 cases died during the first week after trauma. The main, clearly detectable causes of death were pneumonia (30) and thromboembolism of the lungs (22). Fat embolism was responsible for death in at least 6 cases (3 intra- and 3 postoperative); in 2 additional intraoperative and 7 early postoperative deaths, a potentially lethal fat or bone marrow embolism occurred together with other deadly factors. A fat embolism was present in 9 cases within the first week, diminishing with survival time. Hip replacement was clearly dominant for the genesis of pulmonary fat embolism: in none of the early post-endoprosthetic deaths was there little or no fat embolism in contrast to the other types of operation. Bone marrow embolization can induce the formation of multiple small, red intravenous thrombi-possibly a factor explaining the lethal outcome in only a few cases with intraoperative fat embolism. This form of "thromboembolism" must be differentiated from typical lung thromboembolism, originating from a preceding venous thrombosis.

Aged↗

PubMed1994

Unusual findings in a case of suicide with a gas weapon.

Case report on a suicide with a gas pistol loaded with 8 mm blank cartridges. A 58-year-old male shot himself in the right temple and then in the back of the neck. The contact shot wounds showed large wound cavities with interspersed powder particles. The soft tissues were injured solely by the pressure of the exploding powder. Death was due to an air/gas embolism in the right ventricle of the heart.

Craniocerebral Trauma↗

PubMed1994

Cases of death caused by gas or warning firearms.

Five cases of lethal injuries caused by gas or warning firearms are discussed. In one suicide case a modified weapon (elongated barrel) and steel bullets were used to fire a shot into the head, the bullets lodged in the skull and lethal bleeding resulted. In the other cases conventional gas weapons without evidence of alteration were used for contact shots; injuries were caused by the effect of propelling powder gases. Two of these cases were suicides (temporal contact shot and back of the neck contact shot), one was an accident (inguinal contact shot with lethal bleeding), and one was an attack by another person with a contact shot against the neck with bilateral tears of the hypopharynx. After successful surgery, a delayed death occurred 12 days later caused by bleeding into the airways from the ruptured external carotid artery.

Adolescent↗

PubMed1992

[Puncture of central veins in homicide cases].

Puncture of a major cervical veins for insertion of a central venous catheter is a standard-method in resuscitation performed in emergency conditions. Even extensive lesion-marks due to punction are customarily seen by medico-legal practitioners, but in detail they may cause difficulties in differential diagnosis, when lesion marks caused by acts of violence directed straight against the neck are to be differentiated. Especially in the primary phase of inquiry about crimes of homicide these injuries due to punction are forensically important. Therefore frequency and methods of resuscitation efforts were evaluated in 453 crimes of homicide, committed in Göttingen and Berlin (subjects given by the Free University). Findings of the present study were that resuscitation measures were taken merely to a rate of 25%, and in proceeding a central venous catheter was not obligatorily inserted, moreover proceeding being regionally different. In Berlin a central venous catheter was inserted in 17 cases out of 77 resuscitated homicidal injuries, the rate being 24 cases out of 36 cases in Göttingen. In altogether 8 crimes of homicide committed by immediate attacks against the neck, a cervical vena was punctured, findings later being extensive effusions of blood marked around the tapped spot. The different ways to perform resuscitation may justify to point also at the forensic interest to discover the facts together with complete diagnosis in cases of crimes of homicide. That is why it may be vindicated to try to find out a proceeding, which does not lessen the effectiveness of resuscitative manoeuvres, yet by means of which forensical concerns are taken into consideration, too.(ABSTRACT TRUNCATED AT 250 WORDS)

Autopsy↗

PubMed1991

[Untreated hemothorax with fatal sequelae].

A 52-years old woman fell downstairs at home and suffered fractures of the left 9. and 10. rib. She was admitted to hospital; a small subcutaneous emphysema was seen over the fractures. Primary radiograph of the chest showed no internal complication. The patient was observed over night on intensive care unit without abnormalities. Next morning she was transmitted to the regular ward; on this way a control chest-radiography was made. A large hematothorax was seen. The radiologist tried to telephone with the surgeon at the new ward, who was not available because of operating. The nurse at phone (novice) misunderstood the message or the correct message was wrong interpreted by the other nurses in the sense that they believed that the patient had a history of (treated) hematothorax, so that no acute treatment was necessary. The surgeon was not informed, when he came later; the patient was brought from the x-ray station and nothing more happened. About 10 hours later the woman died. The radiologist has been condemned by reason of killing due to carelessness; the fine was placed on probation. In the opinion of the court the radiologist--as the only person, who knew the acute and unexpected condition of the patient--rejected against his liability to guarantee the life of the patient, since he not maked quite sure that the woman really received the needful treatment.

Female↗

PubMed1991

[Fatty degeneration of liver sinusoids in fetal asphyxia].

The fat content of the liver sinusoidal cells was examined partly systematically partly by selected case groups from 297 cases. While minor grades of lipid content within these cells was found nearly equally spread at all causes of death the most intensive fat accumulation was seen at cases of violent asphyxia.

Asphyxia↗

PubMed1991

[Arterial misplacement of a central venous catheter with a fatal cerebral embolism].

A 26-year-old woman came to hospital with an acute abdomen and a history of abdominal pain for about 6 months. She showed signs of peritonitis and ileus and underwent a laparotomy after initial diagnostic procedures. There was massive terminal ileitis with perforation and localized peritonitis. Resection of the affected bowel was performed over 5 1/2 h without surgical or anesthetic complications. Postoperatively several attempts were made to insert a venous catheter via the internal jugular vein, first on the right and then on the left side. The catheter was finally placed and was used for infusions, although there were some signs that indicated a possible arterial position. Neurological disturbances followed the end of anesthesia; 2 h later the catheter was removed because of arterial malpositioning diagnosed by a blood gas analysis. The patient developed brainstem and cerebellar infarctions and died 2 days later. The main postmortem finding was massive swelling and paleness of the cerebellum and brainstem with macroscopically unaffected supporting arteries. The other main arteries of the head and neck were also unremarkable, except for two healing punctures of the left common carotid artery. Further examination revealed an embolism at the top of the basilar artery. The source was macroscopically obscure; stereomicroscopic examination of the heart showed small dark spots behind one fold of the aortic valve caused by parietal thrombosis of the damaged endothelium. The tip of the misplaced catheter had entered this region and caused the lethal embolism.

Adult↗

PubMed1990

[Pressure damage of the hypopharynx caused by stomach tubes].

Analysis of 70 cases of death after intensive care of different survival time and various causes of death. All persons were intubated and had nasogastric feeding-tubes. Bleedings into the PCA-muscles were found in 50% of all cases (especially in short-term survival: up to 80%). Bleedings in this region are not specifical; there are many possible causes. In 27 cases lesions of the hypopharyngeal wall as the result of pressure by the lying tubes were found up to ulcerations; sometimes just after about 1 day. Frequency and deepness of this lesions increased with the time of survival. Even if the hypopharyngeal wall was intact, there are often circumscripted (histologically detected) destructions inside of the PCA muscle(s), caused in part by the pressure of the tube.

Aged↗

PubMed1990

[Spontaneous subdural hemorrhage of natural cause in metastatic renal cell carcinoma].

A 51 years old woman was complaining about pain in the back and headache. Because of sudden change in behaviour she was brought into hospital by her husband. At hospitalization she was unconscious, the first examination showed no hints for trauma. After diagnosis of a bifrontal subdural haematoma intracranial blood was removed twice by neurosurgeons. The woman died six days after hospitalization. The forensic autopsy showed rests of subdural blood and apart of medical intervention no injuries were seen. In the left kidney a carcinoma was found with metastasation in the adrenal glands, the liver, and the dura. The metastasation of the dura had led to destruction of the dural vessels with consecutive subdural bleedings. These hemorrhages probably had been supported by decreased coagulation because of metastasation of the liver. Although such spontaneous non-traumatic subdural bleedings are rare it is obvious that they can cause severe problems by delivering an expert opinion.

Carcinoma, Renal Cell↗

PubMed1990

[Non-strangulation-induced injuries of the larynx and hyoid bone].

Injuries of the larynx and hyoid bone resulting from forces other than compression of the neck were found in 129 of 5591 cases (2.3%) of medico-legal autopsies performed between 1978-1987. Victims of blunt trauma showed these fractures in 6.7%, victims of incides or stab wounds in 9.2%, other cases in 0.4%. The results were compared with clinical observations of laryngotracheal trauma.

Adolescent↗

PubMed1990

["Alcohol associated" death in a forensic medicine autopsy sample at the Berlin Free University].

From 1978 to 1988 6431 forensic postmortem examinations have been made at the Freie Universität Berlin. These are about 50% of all p. m. examinations in Berlin (West) of the corresponding period. 22% of these cases were associated with alcohol. On one hand there was an acute influence of alcohol, on the other hand there were indications of chronic alcoholism. A rise of alcohol associated cases or of alcohol concentrations could not be found out.

Adolescent↗

PubMed1989

[Spontaneous degeneration of the posticus muscle].

The intrinsic muscles of the larynx were prepared in 265 forensic postmortems (death by strangulation: 73; other violent deaths: 93, natural death: 79, others: 20) for a histological examination. Muscle-fiber alterations were found in the (macroscopically normal) PCA muscle in most cases where the persons were of middle age or older. There were abnormalities such as rows or clumps of nuclei (also inside muscle fibers), the accumulation of lipofuscin pigment, focal or total necrosis of muscle fibers with or without predominant histiocytic infiltration, atrophic muscle cells, and fibrosis. The changes were mostly mild (normal muscle cells predominated) but clearly visible. If there had been acute damage to the larynx (for instance, death some time after attempted strangulation), these preexistent alterations must be taken into consideration when interpreting the microscopical findings.

Adolescent↗

PubMed1989

[Extra- and intracranial injuries of the cerebral arteries as a sequela of assault].

The case of an 47-year-old man is reported, who was injured in a fight while under the influence of alcohol. The culprit knocked him down and stamped several times on the left side of his head. The victim became unconscious. At the hospital, subarachnoid hemorrhage and massive ventricular bleeding was diagnosed via CT. Despite the implantation of a ventricular shunt, there was repeated massive cerebral pressure and arterial bleeding. Brain death occurred after 8 days. The main finding at autopsy was nearly complete disruption of the left inferior posterior cerebellar artery as the source of the lethal bleeding. The histological examination showed some additional, incomplete ruptures of this vessel and of the left intracranial vertebral artery. This is a typical result of "minor head injuries" sustained in fights: arterial rupture (ipsilateral) as a result of overstretching. Fracture of the left zygomatic arch and maxilla; no skull fracture; no primary traumatic brain damage. The extracranial carotid arteries were intact. When the vertebral arteries were examined (in the undamaged cervical spine), there was a surprising finding: distant dissection of the right vertebral artery between C1 and C2, which perhaps occurred as a result of compression (contralateral to the impact) of this region.

Arteries↗

PubMed1989

[Traumatic cerebral infarct in multistage dissection of the extracranial internal carotid artery].

A 26-year-old motorcyclist bounced against the side of a turning car with about the speed of 70 km/h. On admission to the clinic, he was awake with stable circulation. The main injuries were contusion of the chest with pneumothorax on the right side, blunt trauma of the abdomen without hematoperitoneum, and a fracture of the right femur. There was no visible trauma of the head, but only circumscribed cutaneous bleeding on the right side of the neck. About 16 h later, he showed an alteration in his level of consciousness and gradually "malignant" cerebral infarction of the left hemisphere with increasing intracranial pressure developed. Brain function began to cease and death occurred on the 4th day. The autopsy revealed neither traumatic damage to the skull, brain or cervical spine, nor were there pathological findings in the cerebral vessels. The main damage consisted of multiple dissections of the inner wall of the left internal carotid artery and the left medial cerebral artery. Proceeding from a temporarily sealed tear of the extracranial vessel, a large intramural hemorrhage had occurred between the media and adventitia and had compressed the lumen completely. The intracranial portion was closed by expanding thrombosis. These lesions are of indirect origin and are the result of vast overstretching of the arteries by the head turning over the edge of the top of the car. The victim was found at once after the crash with his body hanging the deeply dented side of the car and the head (with the helmet on) on the roof.

Adolescent↗

PubMed1989

[Practical use of a personal computer at the work site].

Examples for data processing in forensic medicine: special functions of text programs as mail-function or working with flourishs allow effectual working of printed forms or simple making of bills with adjustment of all individual data and automatic calculating. Based upon a frame of the always necessary text passages and 15 data files of flourishs (one belonging to each letter) an autopsy report was builded up. Using th database program dBase III plus the postmortems of the last 10 years (nearly 6000 cases) were registered (about 50 variables). Evaluation followed from a selfmade program, which supplies two sides tables. The organization of the bibliography (beginning already in subscription) and the administration of (several thousand) dia slides was managed by this database program too.

Autopsy↗