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Biomedical subjects

K S Saternus

Publications and source records attributed to K S Saternus.

At least 19 recordsLinked to original sources
PubMed2006

Some medicolegally important aspects of symphyseal injuries due to trauma.

A total of 58 cases of fatal trauma (forensic autopsies) were investigated for lesions of the pelvic girdle, the pubic symphysis, and for injuries distant from the pelvis. Traumata of the pubic symphysis were present in 30% (n = 17) of the cases. The symphyses were examined by x-ray and macroscopically related to the main violence (Abbreviated Injury Scale [AIS]). A correlation between the latter and the severity of the resulting injuries could be deducted. Characteristic patterns of symphyseal injuries included small hemorrhages, partial and complete ruptures, and also ruptures of the ligamentary insertions, which have not yet been described. The kind and severity of these lesions related to the intensity/direction of the violence are demonstrated and discussed.

Abbreviated Injury Scale↗
PubMed1999

On the contamination of ambient air by preparations carried out with a band-saw.

The aim was to evaluate contamination by bone-dust and formaldehyde when using a band-saw for preparations of the base of the skull and the cervical vertebral spine (stationary band-saw, 1400 upm, saw blade with 160 saw teeth/m; distances 19-26 cm, time intervals 55-90 s). The asservation of bone particles was done with adhesive microscopic slides and calcium-specific staining by alizarin-red. The quantification of air contamination was carried out with micrometry and a particle-counter. Dräger-tubes 0.2/9 were utilized for estimation of formaldehyde. The band-saw did not produce high amounts of bone-dust with suspension power. Nevertheless, 75% of the particles ranged below 5 microns in size and were respirable. Contamination decreased with an increasing height above the floor. A massive flow of particles was observed during the first minutes of sawing. The bone-dust spread some metres away. The formaldehyde levels ranged throughout between 0.5 and also over 5 ppm (MAK = 0.5 ppm). This fact makes clear an intensive contamination of the air. Therefore, a ventilation directed to the floor is necessary when a band-saw is used, as well as breathing masks and safety-goggles.

Air Pollutants, Occupational↗
PubMed1999

[The evaluation of experimentally induced injuries to the upper cervical spine with a digital x-ray technic, computed tomography and magnetic resonance tomography].

PURPOSE: To compare digital X-ray, CT, and MRI in the evaluation of ligamentous and osseous lesions in upper cervical spine specimens after artificial craniocervical injury with the findings of macroscopic preparation. MATERIALS AND METHODS: A rotation trauma of defined severity was applied to 19 human corpses. After dissection of the neck specimens, digital X-ray (DIMA Soft P41, Feinfocus), conventional and helical CT (CTi, High Speed, GE, collimation 1 mm; pitch 1.0), and MRI were performed from the skull base to C3. The findings were correlated with the macroscopic results of preparation. MR (Magnetom Vision, Siemens) imaging was obtained with a 1.5 T system using 2D- and 3D-sequences. RESULTS: Preparation revealed 6 fractures of the vertebral bodies, 5 fractures of the dens axis, 1 fracture of the arcus anterior of the atlas, 4 osseous flakes at the occipital condylus, and 6 lesions of the alar ligaments. Digital radiography showed all fractures and 4 osseous flakes at the occipital condylus. With conventional and helical CT, all fractures and all ruptured alar ligaments could be detected. 2D MRI depicted 9 of the fractures and 3D MRI showed fractures. With 2D MRI, 2 of the 4 osseous flakes at the condylus could be detected and with 3D MRI one occipital condylus fracture could be depicted. Ligamentous injuries were visualized by 2D MRI in 2 of 6 cases and by 3D MRI in one case. CONCLUSIONS: In post-mortem studies, CT was superior to MRI in the visualization of osseous and ligamentous injuries after trauma of the upper cervical spine. However, these results are not transferable to patients with rotation injury in general.

Aged↗
PubMed1998

High cervical stress and apnoea.

The aim of this study was to investigate vegetative reactions in infants after mechanical irritation of the suboccipital region. The investigation is based on 199 infants who were observed while being treated with a suboccipital impulse (manual therapy). The results revealed vegetative reactions in more than half of all cases (52.8%, n = 105). The frequency of such vegetative reactions observed was at follows: flush 48.7% (n = 97), apnoea 22.1% (n = 44), hyperextension 13% (n = 26), and sweating 7.5% (n = 15). It is pointed out that approximately 25% of all the infants examined reacted by apnoea due to a mechanical irritation of the suboccipital region. This symptom was part of an extensive vegetative reaction. This method of inducing an apnoea has not yet been described; from this it follows that there are close relations to sudden infant death.

Apnea↗
PubMed1998

Axonal injury--a diagnostic tool in forensic neuropathology? A review.

We used beta-amyloid precursor protein (beta-APP) to investigate our own forensic neuropathological case material (n = 252) in light of the current literature on the phenomenon "axonal injury" (AI) to determine the incidence, specificity and biomechanical significance of AI and its significance for determining vitality and survival time. The case material consisted of cases of fatal nonmissile closed-head injury (n = 119), gunshot injury (n = 30), fatal cerebral ischemia/hypoxia (n = 51), brain death caused by mechanical trauma (n = 14) or nonmechanical injury (n = 18), and acute hemorrhagic shock (n = 20). AI was observed in 65% to 100% of cases of closed-head injury, fatal cerebral ischemia/hypoxia, and brain death with a survival time of more than 3 h; AI could not be detected in the cases of acute hemorrhagic shock. A statistically significant difference between traumatically and nontraumatically induced (nondisruptive) AI was not found. There was no statistical evidence of a correlation between AI and the different types of external force, since AI could be demonstrated after both acceleration/deceleration injuries and traumatic impact. Therefore, biomechanical inferences for reconstruction purposes are not possible. On the other hand, beta-APP was found to be a definite marker of vitality. In our material, cases with a posttraumatic interval of under 180 min did not express beta-APP. Moreover, the literature shows that the posttraumatic interval can be determined by other methods for demonstration of AI such as by ubiquitin immunostaining (360 min), silver staining (15-18 h), hematoxylin and eosin staining (about 24 h), or by demonstration of a microglial reaction (about 4 to 10 days) or of a few remaining isolated bulbs, without accompanying fibers, which can be detected after a survival time of up to 17 months.

Adolescent↗
PubMed1998

["I have killed my child". Experiences with severe depression in mothers after sudden infant death from the psychiatric and legal medicine viewpoint].

Grief and depressive syndrome belong to normal reaction by parents after a sudden infant death (SID). In the following we report on two cases from the point of view of psychiatry and forensic medicine in which, subsequent to SID, mothers reacted with extremely grave depression and accused themselves of having killed the child. Furthermore, some recommendations are given for the care of parents affected.

Delusions↗
PubMed1998

[Sawdust in autopsies: production, spreading, and contamination].

Airborne infections are well known in clinical medicine (transport of bacteria by aerosols). During autopsies floating, respirable kinds of bone dust are produced, depending on the type of saw. Experiments were carried out with oscillating saws (without/with exhauster) and manual saws (autopsy of cranial cavity). The intention was to characterize and quantify the sawdust produced by the different saws. Furthermore, we wanted to find out whether bacteria are transported by these aerosols. Bone dust was collected with adhesive microscopic slides. Alizarin red was used for solid histochemistry of bone particles. Quantification was carried out by an eyepiece micrometer. Airborne particles and bacteria were identified macroscopically per unit of time. The oscillating saw without exhauster produced sawdust in large quantities. This dust was respirable and had suspension power for hours. There was a remarkable reduction of sawdust by an integrated exhauster. Spreading of particles carrying bacteria/saccharomycetes was seen over 6-8 m. There is a very low risk of an airborne infection when utilizing a manual saw (production of particles similar to chippings, absence of suspended sawdust). It is necessary to take every precaution against airborne infections by wearing breathing masks and safety goggles when using an oscillating saw.

Air Microbiology↗
PubMed1998

[Heavy metal incorporation as an unusual self-injury].

A 19-year-old man was admitted to hospital because of uncharacteristic neurologic symptoms. During the first examination morphologic alterations due to an injection of mercury into the left arm and the left side of the trunk were found. The dose and the manner of application were doubtful and suspected to be a case of self-infliction. The man informed the police only 7 months later because his relatives had finally persuaded him to do so. The description of the infliction by unknown perpetrators was full of contradictions. Initially the patient gave only an indistinct description. But later on, the number of details increased. At the same time there was a change in the characteristics of the perpetrator(s). Other differences existed concerning a loss of consciousness which should have been caused by a single stroke on an arm. Furthermore, the patient told about a swelling as big as an egg, provoked by an injection of liquid mercury. It could be shown by experiments that mercury can be injected into soft-tissue very simply and that it spreaded widely. Arguments for a self-injection were e.g. the technical possibility, the topography of the injection marks, and an easy handling of the syringe. A psychiatric examination furthermore revealed, that the patient had had periods of restriction of thinking, sometimes combined with a lack of appreciation.

Adult↗
PubMed1997

The discrimination between overt and non-overt self-inflicted lesions.

Injuries following autoaggressive behaviour are found in patients examined in forensic medicine as well as in psychiatric clinics. Self-mutilation often is combined with a borderline personality disorder in psychiatric patients. Our investigation compares injuries and wounds in psychiatric patients and those in persons examined in the Institute for Forensic Medicine after referral by the police. Our intention was to show evident differences and/or conformities in both of these groups. Additionally we describe a 'third group' of patients which has not yet been mentioned. These women showed, at the same time, characteristics of patients with overt self-injuries and of those with non-overt self-injuries. In this 'third group' we can often find a mixture of reality and fantasy/imagination.

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↗
PubMed1990

[Do bacteriologic-chemical drinking water studies of households with suspected SIDS have significance?].

In 30 households with SIDS the drinking-water was studied microbiologically and chemically regarding its bacteriological contents, also it was checked for Pb and Cu. Three test solutions of 45 bacteriologically researched samples revealed significant data. One sample showed 2400 cfu "colony forming unit" which is more than double the number of germs permissable in an drinking-water container according to the standards of drinking-water (TrinkwV) 1(3). Also Ps. aeruginosa were found. A further sample contained 3300 cfu Coliforme (E. cloace in 100 ml). The lower quality of a further samples with 2.6 x 10(6) cfu could be retrospectively explained by works done by the Berlin City Works (Berliner Wasserwerke). Enteric bacteria could not be revealed. The remaining 42 samples were within the criteria Section 1 [(1), (2), (3)] of the drinking-water standard. Samples which fulfilled the norms of Section 1 (3) TrinkwV for reserve containers with up to 1000 cfu can be explained by the known fact that water in pipes (containers) can easily be contaminated from outside, for instance through germs like Pseudomonades. In none of the samples a connection between water quality and bacteriological post-mortem findings could be found. In two groups concerning the research for heavy metal the amount of Pb did not surpass the limit of drinking-water standards. In several cases the amount of Cu surpassed that of Pb. Bacteriological-chemical water research in households with suspicion of SIDS are only useful if anamnestical, clinical and autoptic data can be brought into a close temporary and spatial order and if the findings can be controlled through repeated research.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteriological Techniques↗
PubMed1989

Cytological investigations on the cerebellar cortex of sudden infant death victims.

The study was based on the hypothesis that cerebellar hypoxia may play a role in sudden infant death syndrome resulting in morphological changes of the cerebellar cortex, especially with respect to Purkinje cell density. In the morphological evaluation of the Purkinje cell layer, special consideration was additionally given to secondary alterations (i.e., macrophage and/or astrocyte reaction). A total of 12 sudden infant death syndrome cases were compared with an age- and sex-matched control group. The Purkinje cell density was evaluated by determining the number of these cells per surface unit on parasagittal sections in both hemispheres. The myelomonocytic and glial reaction was demonstrated by immunohistochemical methods using lysozyme as leukocyte and macrophage markers and glial fibrillary acidic protein as an astrocyte marker. Qualitatively, no alterations resembling a macrophage or glial cell reaction were detected in sudden infant death syndrome. No differences between the right and left cerebellar hemisphere could be established in the victims of sudden infant death syndrome nor in the controls. The number of Purkinje cells per 0.352 mm2 cortex was higher in the younger victims of sudden infant death (younger than 45 weeks of gestation) than in all matched controls. A statistically significant difference in Purkinje cell density, however, could not be established, and, especially, no indications of hypoxia were observed in the cerebellar cortex.

Cerebellar Cortex↗
PubMed1987

[Forms of fractures of the occipital condyles].

In contrast to the large fracture system of the base of the skull, little attention has so far been paid to fractures of the occipital condyles. The mechanics of these fractures have mostly been described in the form of case reports. Here an attempt is made to classify fractures of the occipital condyle based on the literature and our own material. Fractures of the condyles in the sense of bursting or the injuries themselves are classified under the following forms of strain: 1. Axial compression (Jefferson type) condylar impression; 2. Axial traction (hangman's type) condylar retraction; 3. Rotation with axial strain condylar retraction; 4. Oblique compression (bursting fracture of the abutment) frontal condylar fracture; contralateral; 5. Oblique traction (horizontal thrust); a tearing at the base of the skull as in a contralateral condylar horizontal fracture; 6. Transverse thrust (longitudinal fracture of the base of the skull) partial condylar avulsion The functional connection between a longitudinal clivus and condylar fracture is illustrated by typical examples. Furthermore, the elliptical deformation model for a burst fracture at the base of the skull in the longitudinal axis is extended by the deeper transverse thrust stabilization of the condyles.

Accidents↗
PubMed1987

[Traumatology of the alar ligaments].

A postmortem study of craniocerebral traumas of varying severity was done to determine the pattern of injury of the alar ligaments. It was found that in the entire group of patients (n = 30) the alar ligaments were ruptured or suffused with blood 11 times. No close relationship was found between the massive nature of the cranial trauma and the severity of the injury of the alar ligaments. In some cases the alar ligaments were not at all involved even though the skull had suffered extensive osseous lesions, whereas on the other hand the ligaments were injured even though only soft parts had been involved (e.g., haematoma or dehiscent wounds of the scalp). Ruptures of the alar ligaments were typically involved in extended ruptures of the ligamentous apparatus (see Figure 6a involving the ligamentum apicis dentis, ligamentum transversum atlantis, m.atlanto-occipitalis anterior, m.tectoria, m.atlanto-axialis anterior et posterior). In some cases the pattern of injury of the alar ligaments was found to be decisive in enabling reconstruction of the course of the accident. Damage to the alar ligaments near the dens axis represent rotation injuries. On the other hand, insertion tears out of the condyli occipitales must be related to a lateral thrust tendency in indirect fracture of the skull (bursting fracture). Within this overall framework a new mechanism of fracture of the condylus occipitalis is described. As a matter of principle, the alar ligaments can become involved in consequence of rotation, traction and compression of the cranium.

Brain Injuries↗