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Biomedical subjects

H Maxeiner

Publications and source records attributed to H Maxeiner.

At least 73 records · Page 4Linked to original sources
PubMed1984

[Iatrogenic biliovenous fistula].

A 44-year-old man had suffered from cholecystolithiasis with recurrent jaundice for many years, and a cholecystectomy was carried out. Because of a radiomanometric obstruction of the common bile duct, the intra- and extrahepatic bile ducts were also scanned. One day after the operation the jaundice increased (serum bilirubin max. 742 mumol/l). The cause of the icterus was found in a small biliovenous fistula, and diverse surgical and angiological attempts to resect or close the fistula failed. In the third postoperative week renal failure developed, followed by a disturbance of coagulation and insufficient respiration and circulation. The man died 33 days after the operation. Autopsy showed massive jaundice, gastrointestinal bleeding, and cholemic nephrosis. Extensive preparation of liver resulted in a 20 X 8 X 15 mm fistula in the right lobe 9 cm proximal to the choledochotomy and anastomosing a thin branch of the right hepatic duct and a small hepatic vein. Long-time bilhemia resulted from this fistula and entailed renal failure and finally death. The fistula obviously resulted from scanning the bile ducts when the catheter was accidentally deviated into a biliary duct that was too small.

Adult↗
PubMed1982

[Remarkable findings in the criminal dismemberment of a corpse].

The objects of examination were two legs and two arms that were recovered at different times from waters traveled on by motor ships. The right leg was exarticulated at the hip joint, as was the right arm at the shoulder joint. Identification was complicated since both thumbs were exarticulated at the basal joints; the fingers II to V, respectively, were partially amputated. Identity (57-year-old vocational school teacher) could be established nevertheless by a number of anatomic findings (such as Dupuytren's contracture, coxitis, hallux rigidus), the blood group "O" was tatooed on the inner side of the left upper arm. The results of the laboratory examinations were only of limited use due to advanced decomposition (beginning formation of adipocere). Special attention should be given to the fact that on the same part of the corpse there were signs of defensive corpse dismemberment and injuries from a ship's propeller as well. Under no circumstances can an examination of the bones, after thorough maceration, be dispensed with; X-ray examinations are also imperative in cases of this nature.

Amputation, Traumatic↗
PubMed1981

[Longitudinal tears of the vertebral arteries. Calculations and experimental findings concerning the conditions (author's transl)].

In the preceding publication (see p. 1) the question arose of how to explain the longitudinal tears of the vertebral arteries at the departure of the posterior inferior cerebellar artery, that occur as origin of fatal subarachnoidal hemorrhage subsequent to blunt forces against the head. As the result of calculation of flow dynamics in a right-angled branching a curvature of the main vessel opposite to the flow in the branch develops. If the main vessel is unable to evade, the branch will be impressed into the main vessel in a piston-like manner. An experiment with silicon tubes succeeded to produce longitudinal tears resembling to those described by Krauland. Traumatic increase of pressure and stress of the vessels are considered the most likely cause of longitudinal ruptures of the basal arteries.

Biomechanical Phenomena↗
PubMedDate not supplied

[A postmortem view on "pure" subdural hemorrhages in infants and toddlers].

In the last years, the discussion concerning the causes of infantile subdural hemorrhages became controversial. Many authors still suppose that child abuse is the predominant cause of such cases. On the other hand, reports presenting series of accidental cases were published, and the fear of an overdiagnosis of the shaken baby syndrome has been expressed. Our autopsy material concerning all lethal head injuries of infants and toddlers from 2 decades was reviewed. 17 of these 64 cases were characterized by the following: history of no trauma or only an insignificant event; children found dead or apnoic or in coma; no skull fractures; no focal brain injury; ruptures of several bridging veins but only minimal subdural bleeding. 11 victims were infants (1st year of life) and either 3 were 2 years resp. 3 - 6 years old; 50 % off all lethal head injuries of infants were of this type, while only 25 % resp. 10 % of the following age groups. None of these 17 cases was a result of a minor accident witnessed by unrelated persons. Abuse could be ascertained with a high degree of probability in most cases and remained quite likely in the others. Two different types of subdural hemorrhages should be kept from another: a) patients suffering a moderate head injury from a minor accident which results in a subdural bleeding (from a small intracranial lesion) often do not deteriorate soon after the impact, develop a hemorrhage of significant volume, respond well to therapy and have a good prognosis. b) cases with a history of no or only of an insignificant trauma, infants dead or nearly dead on clinical presentation, often a poor outcome in cases of survival. There is typically no significant subdural bleeding despite multiple bridging vein ruptures in the majority of these cases: the subdural hemorrhage is here only a visible sign of a much more serious and general cerebral alteration, resulting in a rapid increase of intracranial pressure (often complicated by respiratory arrest) which prevents a signifant bleeding into the subdural space. This combination of findings is typically found in victims of massive events (car occupants in high-velocity crashes) and not compatible with a supposition of a minor fall causing this.

Accidental Falls↗
PubMedDate not supplied

[Healed fractures of the larynx and lingual bone in forensic autopsy].

Laryngohyoid fractures are a frequently investigated matter, especially in the forensic literature. On the other hand, there are only very few (old) forensic reports of such fractures in survived cases. However, healed fractures are not seldom found in forensic autopsies: In a personal series of 1160 forensic autopsies (adult persons) a careful dissection of the laryngohyoid complex was done by 1 investigator. Only a macroscopic examination of the cartilages was carried out; radiographs and histological slices were not regularly made. Therefore only a part of existing old fractures is detectable; for example, healed fissures are not visible with this simple method. Furthermore, asymmetries of the thyroid laminae cannot be declared as posttraumatic without additional examination, because this condition is described as possible anatomic anomaly. From that, the injury frequencies presented here only mark the lower threshold of the existence of such findings. Healed fractures of the upper thyroid horns and the major hyoid horns can be easily detected even in a routine examination, if healing resulted in a fixed dislocation or apposition of bone surrounding the former fracture site. In the present series, this was the predominant localization of old fractures: the upper thyroid horns (43 cases), followed by the hyoid cornua (12 cases), a combination of both sites (5) and cricoid fractures (5). Of the total 65 healed fractures (5.6%), 35 were found in the group of 290 chronic alcoholics (12.1%) and only 3.4% in non-alcoholics. In the subgroup of middle-aged alcoholics, the fracture rate increased up to 19%. However, this group did not present a higher rate of fresh laryngohyoid injuries (not related to strangulation) than the other cases. The old fractures probably resulted from minor "daily" injuries (like falls), which are common, especially in chronic alcoholics. The frequency of such findings should be in mind if an apparently fresh fracture, found in an actual autopsy, should be related to the cause of death: there is a real chance, that this fracture occurred prior, and without causal connection to the factors resulting in death. Therefore a histological examination of the age of this finding is necessary. Cricoid fractures are quite uncommon, except in serious external neck trauma. In 1 of our 5 cases, this fracture was caused by repeated cruelty, finally resulting in death.

Adult↗
PubMedDate not supplied

[Eyelid petechiae and conjunctival hemorrhage after cardiopulmonary resuscitation].

In the last few years, some reports claim that petechial bleedings found in the eyelids and conjunctivae of corpses may be resp. are caused by resuscitation efforts (= RES). Nevertheless, the numbers of cases were small and the selection of the cases presented to demonstrate this relation in our opinion was not convincing. In the material of our institute, the rate of autopsies in which the victims had been tried to resuscitate by professionals increased up to ca. 25%, including a substantial number of victims of homicides. If RES alone would cause petechial bleedings, serious problems would arise for the medical expert. We analyzed all cases of a period of 5 years, which were examined by 1 investigator. Among 474 autopsies, RES was done in 144 cases (31%). 19% of these victims presented petechial bleedings, predominantly in the conjunctivae, compared to only 11% in the non-RES group. However, this was not a consistent finding in all subgroups: If the group of acute cardiac deaths of middle-aged persons was taken separately, in the remaining material a statistically significant difference in the petechial rate between cases with and without RES was not present. The analysis revealed an influence of the following factors in the development of petechial bleedings: cause of death, age, constitution (body mass index). In the RES subgroup with the highest rate of petechial bleedings (acute cardiac deaths of persons between 40-60 years; n = 23; rate of petechiae = 50%) the frequency of petechiae could be explained by a combination of such factors. As a second way we investigated all persons in which RES was done in our Medical School during a period of 5 months. In no surviver petechiae were present; in the group of non-survivers (predominantly cardiac deaths), the petechial rate was 16%. According to the statements of the treating physicians, a development of petechial bleedings under RES was not striking in these cases or according to their general experiences. Although such a statement is of restricted value (because petechial bleedings are mostly not obvious without a special look for them), the complete absence of information of this aspect in the clinical literature is striking. If petechial bleedings would be a common consequence of RES, this finding should be well known in intensive care units. According to our experience, a clear causal relation between resuscitation efforts and petechial bleedings in the face is not likely.

Adult↗
PubMedDate not supplied

[Cervical findings and petechial hemorrhages in falls from high positions].

Cases of combined suicide are infrequent findings, especially cases in which each method can be lethal. In interpretation of cases with a multitude of serious injuries it might be impossible to discover minor injuries which had occurred in the course of a preceding confrontation, because they may be masked by the general traumatization. In two cases of suicidal fall from a height neck injuries and petechial bleedings were found. The first case (woman 53 years) was a combination suicide (strangulation by ligature, deep incisions into her wrists, jump out of the window). The intensive petechial bleedings in the face could be explained as a result of ligature strangulation and the fracture of a lower thyroid horn as an indirect fracture resulting of the head traumatization. In the second case (girl, 14 years) petechial bleedings in the face were found. Furthermore the victim had marks on her neck-skin, consisting of well-lined bleedings and scratches, presenting a clear pattern, which could be related to a necklace. An explanation of these injuries as a result of a direct impact could not be given. Something must have happened prior the fall. Informations concerning the last hours before her suicide could not be obtained but a strangulation-attempt (by herself? by others?) must be ascertained. The histological investigation of the skin of this region arised a negative vital reaction, therefore a very short interval between that event and the death was assumed.

Adolescent↗
PubMedDate not supplied

[Site, number and depth of wounds of the scalp in falls and blows--a contribution to the validity of the so-called hat brim rule].

The sites, numbers and lengths of wounds of the skin of the scalp and head caused by blunt injuries (falls from standing position, falls downstairs, blows) in an autopsy series. Analysis of the localization, length and number of wounds located at the head in 305 autopsy cases of falls from a standing position (203 cases), falls downstairs (51 cases) and blows with relatively long materials (51 cases). For the distinction between falls and blows, among several other aspects the so-called rule of the hat-brim-line is described: in cases of falls from a standing position down to a flat bottom, contusions can be expected in or near a line which represents the greatest horizontal circumference of the skull, whereas in cases of blows the contusions lay above this area. Although such a tendency was found in our material, a rule could not be confirmed: only approximately 55% of the wound due to blows were above this line, and in cases of falls from a standing position ca. 1/3 of the wounds were above this area. Only in the (dorso-frontal and parietal) region "top of the head" contusions due to falls from a standing position were quite uncommon. The mean length and length distribution of wounds in the hat-brim-zone was not different between the 3 causes of injuries; in positions above this, wounds due to blows were longer compared to those by falls. In falls from a standing position, only exceptionally more than 1 wound was found, whereas in cases of homicide several or many wounds were common. Single wounds due to blows were only found in cases, in which the victims were knocked down but not killed by blunt forces, and death was caused by other methods (e.g. strangulation or stabbing).

Accidental Falls↗
PubMedDate not supplied

[Aspiration of gastric contents in hanging with typical position of the strangulation cord and free suspension].

Among 193 cases of hanging from the years 1978 to 1991 examined in the institute of Forensic Medicine of the Freie Universität Berlin 8 cases with an aspiration of stomach contents had been reported. Herefrom 3 cases were hanging in a "typical" position (suspension point at the back of the head, free suspension of the hanging body) and did not undergo resuscitation. By free suspension of the hanging body the observed massive aspiration of gastric contents only can be explained by an at least partly open connecting passage between the laryngeal entry and the entrance of the oesophagus. The post mortem flowing in of stomach contents as well as a post mortem gastro-oesophageal peristalsis seem not to be able for explicating the findings. Differences in important parameters (e.g. gastric contents, alcoholization) to the cases of hanging without aspiration were not found. Even by free suspension of the body, running noose and point of suspension in the back of the neck sometimes the connection between larynx and oesophagus may stay open, especially when by emesis a high pressure is produced by the stomach.

Accidents↗
PubMedDate not supplied

[How extensive can injury of the larynx in self-choking be?].

Is it possible to distinguish between suicidal and homicidal strangulation by the extent of the injuries of the larynx if the results of the police investigations are uncertain? Therefore evaluation of the German publications (115 reported cases of suicidal strangulation) and our own cases (17 cases). Hereafter more intensive injuries of the neck are extremely rare in cases of self-strangulation. Casuistic: Body of a 40 years old woman with signs of strangulation. The husband declared his wife strangulated herself in the bathtub with the belt of a bathrobe. Autopsy: Typical findings of drowning, intensive injuries of the neck tissues and the larynx. Kind and extent of the findings are speaking well for an assault mainly by manual strangulation. Undepending of the medical findings the police investigations are almost excluding a suicide. Condemnation of the husband.

Adult↗
PubMedDate not supplied

[Injuries and fatalities caused by gas-/warning weapons].

Detailed report of 5 cases of violation with gas or warning firearms, 3 of them lethal. In one case a modified weapon (elongated barrel) and steel bullets were used, resulting in shot of the head with retained missile and lethal bleeding. In the other cases, regular weapons (8 or 9 mm cartridges) were used for contact shots; violation occurred only by the effect of powder gases. One of these cases was a suizide (lethal temporal gunshot), in the other cases shots by another person: a) shot against the arm with large soft-tissue damage (survived); b) and c) shot against the neck with exceeding rupture of the soft tissues, minimal damage of the neck arteries and in one cases bilateral tears of the hypopharynx. In this case a delayed death after primarily well operated injury occurred after 12 days by bleeding into the airways from ruptured external carotid artery.

Adult↗
PubMedDate not supplied

[Morphologic findings for airway occlusion in strangulation].

Report of two cases of strangulation by hand. There were large submucous bleedings of the larynx (both sides of conus elasticus) of symmetrical arrangement, near the vocal processes of the arytenoid cartilages. They are believed to be the result of the violent contact of the vocal folds during laryngeal compression; perhaps while the arytenoid cartilages were subluxated inwards and downwards. Bleedings like this indicate the closure of the airway. In one case (50-year old woman) the ossified cricoid was broken; in the other (21-year old woman) the elastic laryngeal skeleton was intact, but large bleedings of the deeper tissues of both vocal folds indicated the vehement compression too. The analysis of 110 cases of attack against the neck (strangulation by hand -n = 30- or ligature -n = 30- alone or together -n = 32-; blunt force: n = 8, other types: n = 10) showed in 7 additional cases less typical but similar bleedings, especially in strangulation by hand.

Adult↗
PubMedDate not supplied

[Delayed death following strangulation (hanging)].

6 cases of suicide by hanging with delayed death are presented in tables laying out the circumstances and the findings. All the persons involved remained continuously unconscious after initially successful reanimation; two were at this time already dead. The survival times lay between 18 hours and 4 days. In two cases intravital vertebral death occurred. In the other cases death was due indirectly to hypoxial brain-damage which had led to a greater or lesser extent to elective parenchymal necrosis. In 3 of 4 histologically investigated cases there was evidence of extensive cell destruction in the PCA muscle which was, however, not specifically related to the process of hanging since lesions of this nature also occur with other cases of delayed death after reanimation. In 7th case the problems encountered in compiling an expert opinion are discussed in cases where there are no corresponding procedural details. A 44 year old man died 3 weeks after having been submitted to bondage in a brothel at his own request (including binding of the neck). Compression of the throat with emphasis on one side was evident resulting in extensive ganglial cell damage in one half of the cerebral cortex.

Adult↗
PubMedDate not supplied

[Injuries to laryngeal articulations in strangulation and throttling].

During the consecutive examination of the larynges of (81) deceased persons (strangulation by hand and/or ligature, blunt force against the neck, from other persons), the cricothyroid and cricoarytenoid-articulations were prepared and opened, and capsular or articular cavity hemorrhaging was found in 30% of all cases; a clear distinction being found between effect of manual strangulation (43%) or blunt trauma (44%) on the one hand and strangulation by ligature alone (9%) on the other. The greater the extent of injury to the cartilages the more articular lesions are found as an expression of the mechanical load on the entire laryngohyoid structure.

Homicide↗