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Biomedical subjects

H Maxeiner

Publications and source records attributed to H Maxeiner.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Fatal intraoperative lung fat embolism in endoprosthesis of the hip joint].

Report on 3 cases of intraoperative death during total hip replacement in treatment of transcervical fracture of the femur, using acrylic bone cement. The patients were two female (83 and 87 years-old) and one male (78 years old), who suffered from a sudden fall at home. Autopsy revealed massive fat embolism (FE) of the lung and in one case also in the other organs; in 2 cases this FE was the cause of death alone, in the third case together with an unusual severe coronary heart disease (heart weight 700 g). Discussion of the medico-legal aspects, i.e. the coincidence of FE of different causes (traumatic, by operation, by reanimation). Reflections on the certainty to attribute the death to specific (in particular deficient) technical factors.

Aged↗
PubMed1989

[Mucosal hemorrhage of the larynx in strangulation and other causes of death].

Report of the occurrence of bleedings (petechiae, ekchymoses and large bleedings) of the laryngeal mucosa in cases of attacks against the neck (strangulation by hand or ligation, blunt forces; n = 110) and in a continuous series of autopsies of medicolegal cases (natural and violent deaths; n = 1000). In this series altogether in 5.6% bleedings were present; in natural death (5.5%) mostly petechiae due to congestion, in death by force (5.8%) hemorrhages due to direct or indirect laryngeal trauma. A frequent cause of laryngeal bleedings was intubation during reanimation. In the section of strangulation mucosal hemorrhage was present in every second case (altogether 68 cases): petechiae (n = 30), ekchymosis (n = 10), both types together (13) and large bleedings (n = 15), mostly in the elastic conus. Special types are symmetrical bleedings of the vocal folds and/or the deeper parts of the laryngeal mucosa as a result of lateral laryngeal compression (they point at airway obstruction); furthermore lare hemorrhages behind (and insides) the PCA muscles following pressure of the larynx against the spine. With increasing intensity of laryngeal compression (especially due to cricoid fracture) rises the portion of broad extravasates; petechial bleedings most frequently are in strangulation by ligature.

Hemorrhage↗
PubMed1988

[Hemorrhage of the head and neck in death by burning].

The 202 deaths connected with burns in 1976-1986 included 134 in which death occurred during the fire. In 49 cases the face was so badly charred that it was not possible to judge whether hemorrhage had occurred in the eyelids and/or conjuctivae. Such blood extravasation was seen in 14 of the remaining 85 cases, taking the form of petechiae in some cases and in others the form associated with more extensive extravasation, in some cases hemolytic. No other features known to cause such hemorrhages were present, so that they are attributed to the burning process itself. Signs of extensive pronounced burns were found in 13 of these cases, and it seemed that high-degree burns on the neck and trunk with less severe burns on the head were particularly likely to be associated with such hemorrhages. In most cases the flames had quickly come into direct contact with the body (clothing, bed or chair had caught fire), leading to rapid death, as documented by the fact that usually very little or no soot at all had been aspirated and by the low level of carbon monoxide intoxication (max. COHb 22%). One plausible explanation for the development of hemorrhage is the supposition first expressed over 20 years ago that when the circulation is maintained rapid burn-induced shrinkage of the skin of the neck has the effect of strangulating the victim; hemorrhage of eyelids and/or conjunctivae in such cases be could regarded as a vital reaction to the effect of fire. This is particularly significant, insofar as evidence of hemorrhage of this kind was found predominantly in bodies in which other vital signs indicative of the effects of burning were sparse and slight or even totally absent. In addition, specific examination of the laryngeal area revealed congestion-induced extravasation at various points, as well as petechial hemorrhage in the mucous membrane.

Adult↗
PubMed1987

[Local vital reaction following injuries of the neck].

Sixty-one cases of hemorrhaging of the laryngeal muscles are reported among 86 deaths due to compression of the neck (strangulation by ligature and/or with the hands, blunt force); the results of histological examinations of these cases (laryngeal muscles; hemorrhaging of the cervical muscles and tongue in numerous cases) are discussed, as well as 55 comparative cases (natural, violent death) with regard to vital changes from the hemorrhaging aspect. Although sanguineous infiltration of the laryngeal muscles can occur after death (prone position), it differs macroscopically and in some cases also microscopically from the vital type: extensive bleeding on the inside of the larynx or dorsally above the larynx (PCA muscle), possible combined with histologically detectable ruptures of muscle cells, must be viewed as the result of laryngeal compression suffered when still alive. No clear-cut evidence of emigration or infiltration of leukocytes was found in the cases of immediately fatal strangulation, but there was occasional evidence (6 cases) when protracted maltreatment had taken place. Although there was no clear correlation with age, sex, type of impact, cause of death, or amount of laryngeal bleeding, in 25 of the 61 cases leukocytes were sometimes detectable in enormous amounts within the extravasation; the ratio exceeded that to be expected from the composition of the blood. Findings of this nature have also been made in cases of vital bleeding in other violent or natural deaths; they are not a cell reaction in the proper sense but, when distinctly marked, a vital event--at least in the laryngeal region. These findings can support the assumption of the amount of hemorrhaging in deaths in which the survival time was inadequate for a leukocyte emigration. In 20 cases such findings were combined with localized leucocytosis, which is regarded as an early vital reaction.

Asphyxia↗
PubMed1986

[Instructions for the complete preparation of the larynx].

A method of preparing the larynx in forensic cases is described especially when death occurs by strangulation (manually or using some form of ligature). After the usual dissection of the hyoid bone and the upper horns of the thyroid cartilage, the complete larynx is clipped and fixed in formaldehyde overnight. The first part of dissection after that is to cut away the thyroid gland and the remaining muscles in front of the larynx, except for the cricothyroid muscle and the esophagus and hypopharynx from the back of the larynx. The complete thyroid cartilage is dissected out, and then a horizontal cut is made through the cricoid cartilage. Median-sagittal halving of the remaining larynx completes the gross dissection. Arytenoid cartilages are exposed by dissection of the arytenoid muscles and opening the cricoarytenoid joints. Now all parts of the laryngeal skeleton and all articulations are examined, and all muscles and soft tissues are visible and can be clipped for histological examination.

Asphyxia↗
PubMed1985

[Soft tissue hemorrhage within the larynx following strangulation].

The inner soft tissues of the larynx (i.e., true vocal cord, false vocal cord, paralaryngeal space) were examined by special preparation of the larynx: thyroid cartilage was detached from the cricoid and the laryngeal cords, which could then be examined. Bleeding (not visible before) was found in 18 of 40 cases of persons killed by throttling or choking; bleeding occurred whenever blunt trauma of the throat had taken place (n = 8). Hemorrhage develops even in cases without damage to the laryngeal skeleton; this bleeding can result from direct compression of the larynx (large and not well defined bleeding) and can originate indirectly (small hemorrhages mostly in the vocal muscles). The finding of hemorrhages like this can help to demonstrate that the victim has undergone a violent attack on the throat.

Adolescent↗
PubMed1985

[Model experiments on breathing under sand].

Remarkable autopsy findings in persons who had suffocated as a result of closure of the mouth and nose by sand (without the body being buried) induced us to investigate some aspects of this situation by means of a simple experiment. A barrel (diameter 36.7 cm) with a mouthpiece in the bottom was filled with sand to a depth of 15, 30, 60, or 90 cm. The subject tried to breathe as long as possible through the sand, while the amount of sand inspired was measured. Pressure and volume of the breath, as well as the O2 and CO2 content were also measured. A respiratory volume of up to 31 was possible, even when the depth was 90 cm. After about 1 min in all trials, the subject's shortness of breath forced us to stop the experiment. Measurement of O2 and CO2 concentrations proved that respiratory volume in and out of the sand shifts to atmospheric air without gas exchange, even when the sand depth is 15 cm. Sand aspiration depended on the moisture of the material: when the sand was dry, it was impossible to avoid aspiration. However, even a water content of only 5% prevented aspiration, although the sand seemed to be nearly dry.

Airway Obstruction↗
PubMed1985

[Suffocation death by occlusion of the airways with sand].

Eleven cases are reported in which death occurred because of suffocation as a result of occlusion of the respiratory tract by sand (without thoracic compression: 3 cases) or being buried alive (8 cases). Two tables demonstrate the findings and circumstances in the events. Three cases are described in detail. A 22-year-old woman was manhandled by blows and kicks to the head and neck. She became unconscious and her head and neck were covered by a layer of sand so that she suffocated. A 42-year-old man was smothered, while unconscious, in a prone position with his face in the sand, after hard blows to the head by two culprits. A 17-year-old girl finally died by chocking. Previously the culprit had pressed her face into the ground, so that she aspirated particles of soil. The question of vital reactions during aspiration of sand was investigated by microscopic examination of the content of the air passage and by destroying parts of the lungs by sulphuric acid. Minimal aspiration of sand occurred in all cases. Although the postmortal remains were left in the ground, there was no postmortem penetration of sand into the air passage. Histological examinations were carried out to support the diagnosis of violent suffocation. In some cases, there were remarkable findings (mobilization of alveolar cells, hepatocelullar hydropic degeneration), but there were no typical or unanimous findings that pertained to all cases.

Adolescent↗