Biomedical subjects
Publications and source records attributed to M A Verhoff.
The principles of modern forensic DNA-analysis using the amplification of so called STR-polymorphisms are explained. Four cases from practise that required the collaboration of forensic molecular biology and pathology and which were analysed by them are presented and discussed. Similarities and variations in the work of both "disciplines" are presented and suggestions for the storage of samples formulated.
Now-a-days immunoassays are world wide used for the rapid screening of drugs. Despite the fact that they are a highly valuable tool for the test of legal and illicit drugs, there is a non-negligible risk of false positive and false negative findings and many pitfalls must be taken into account when using these tests in an uncritical manner and without valid confirmation procedures.
The practical use of the legally required documentation of occupational diseases is demonstrated by a case of asbestos-related pleural mesothelioma. During the mandatory inquest before cremation, information of manifest pleural mesothelioma had been relayed to the widow of the patient, and an investigation for a possible occupational disease was performed. Reconstruction of the case showed that in the course of 3 months at least 13 physicians had been involved in in-hospital as well as ambulatory therapeutic measures. Until death, none of them informed the trade association about a suspected occupational disease in accordance with BK 4105 of the codex of occupational diseases, although the diagnosis of manifest pleural mesothelioma had been histologically confirmed already 10 weeks prior to the death of the patient. This case demonstrates obvious and evident deficiencies in applying the Code of Social Law VII, which requires physicians to report occupational diseases. In addition, it shows the importance of the post-mortem examination as a control function before cremation.
This case report describes a suicidal gunshot to the head using a solid hollow-point bullet (Quick Defense). There was an irregular skin defect measuring 16 x 6 cm on the right side of the head and a bone defect of 9 x 6 cm while a 1.2 x 0.7 cm skin defect was located at the left temple. This atypical wound morphology caused confusion at the scene but during autopsy, a muzzle imprint and an abrasion ring were found in the frontal aspect of the large skin defect in the right temporoparietal region, which therefore had to be the entrance wound. In addition, extensive backspatter consisting of brain tissue, bone fragments and blood had been expelled from the huge entrance wound and had travelled up to a distance of 4.6 m. The extraordinary entrance wound cannot be fully explained by special anatomical or ballistic features such as a muzzle velocity of 420 m/s or the solid hollow-point design of the bullet.
The state of confusion in patients with severe disorientation and brain damage symptoms presents particular problems in gerontologic psychiatry. Six fatalities at different institutions due to improperly employed physical restraint and deficient surveillance are described. The causes of death involved strangulation which was accidentally caused by patients who become stuck between bedrails and mattress or who were fixed in an abdominal restraint belt or in a special protective blanket (mostly used for serious pre-conditions). The reconstruction of the scene of death was based in almost all the cases on the autopsy findings. We assume a considerable number of unreported emergency or fatal cases. The legal, psychiatric and nursing-related issues are discussed in this paper. Furthermore the precise documentation of the on-site appearance of the situation at discovery of death is called for. The indication for physical restraint should be limited as far as possible. Further studies in nursing homes and hospitals should focus on structural conditions with respect to the frequency of physical restraint in order to optimize the protection by quality standards.
OBJECTIVES: The morphological findings in organ systems following exhumation, form the basis for answering a number of medical insurance issues. The aim of this study was to analyse the development of the number of exhumations performed and the medical insurance relevance over a 31-year-period. METHODS: A total of 371 exhumations, performed between 1967-1998 at the Institute of Pathology, Occupational Associations Hospital, Bochum, for medical insurance reasons were evaluated. RESULTS: The average number of days after burial was 74, ranging from 9 to 47.8. For the first third of the period investigated, the proportion of exhumations was 3.5% of all autopsy cases, for the second third this fell to about 0.4% and rose to 1.5% for the last third. In the first two-thirds, the main reasons for the exhumations were related to the grading and effects of pneumoconioses in connection with the cause of death. In the last third, asbestos-associated diseases were mainly involved. In 99.2% of all cases, the autopsy results revealed important evidence for clarification of the medical insurance issues. The current catalogue of expectations listing the pathomorphological findings which can be expected after certain periods of internment, could be extended by our own results.
We report the pathological anatomy of a patient aged 77 years at the time of death, who suffered from an arachnoid cyst situated near the right lower olive nucleus. This led to palsy of the hypoglossal nerve and partial gliosis of the brainstem with consecutive hemiatrophy of the tongue. This lesion did not seem to have any further effects onto clinical presentation. The patient died of a fulminant lung embolism and also presented an adenocarcinoma of the lung.
Sideroelastosis pulmonum was first described by Ceelen (1931) and Gellerstedt (1939), mentioning an idiopathic type, but also vascular alterations in chronic pulmonary congestion. We analysed the question wether secondary sideroelastosis can be demonstrated also in lungs after previous welder dust exposure. Lung samples of 43 patients and deceased with various exposure periods to welder dust were investigated. On each sample, light microscopical, scan electron microscopical and energy dispersive x-ray micro analyses (EDX) were performed. In six samples (14%) vascular alterations in the area of denaturated elastic fibres with siderophilic "impregnation" were seen, corresponding to the features described by von Ceelen and Gellerstedt. Giant cell or granulomatous reactions, however, were present only in exceptional cases. This phenomenon was seen mostly in cases of marked local siderin deposits and reactive fibrosis. Using EDX, a number of metals characteristic for welder dust (Al, Ti, Cr, Ni) as well as iron were found in siderophages. No other metal than iron was detected in siderophilic elastic fibres using EDX. Causal pathogenetically, a correlation between increased iron uptake connected with welding particles and sideroelastosis of the vessel walls has to be established. However, in formal pathogenesis, other factors such as local perfusion disturbances due to fibrotic processes after exposure to harmful substances must be taken into consideration.
Pathological-anatomical analyses of biopsy and autopsy samples of 43 men with anamnestically established occupational exposure to welding fumes showed in 38 specimens (88%) characteristic alterations of varying degrees of sidero pneumokonioses. Based on recurrent histological findings of increase and activation of iron storing macrophages (siderophages) and varying degrees of fibrosis, sidero pneumokonioses are classified into three grades. Intraindividually and also toporegionally different degrees may well be present. Based on morphological criteria of the three grades, seven samples were classified as grade I, 21 specimens as grade II, and 10 samples as grade III. The results show that exposure to welding fumes may well cause pulmonary alterations reaching an impairment level, depending on length, extent and special circumstances of the respective exposure. In cases of so-called welders lungs, an obliging statement in an expert's opinion on the degree of functional impairment, however, can only be given when histological findings, detailed information on the occupational history and clinical functional parameters are combined.
The authors report on an initially unrecognized fatal accident caused by electric current at the place of work. The source of the current was a satellite dish which had been improperly connected to an old music box with subsequent connection to the household electrocution system (220 V, 50 Hz). Only when a second nearly fatal accident occurred, proper diagnosis and detection of the uncommon source of the electric current was made.