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Biomedical subjects

M Graw

Publications and source records attributed to M Graw.

33 records · Page 2Linked to original sources

[Statistical approach to forensic conversion values for alcoholics].

With collaboration of the study groups from Tübingen, Munich and Kiel and consideration of the results of Bonnichsen et al 1968, alcohol elimination curves of 98 alcoholics were subjected to a joint evaluation for determination of the beta 60 values. The average elimination rate was 0.21 g/kg/h (s = 0.05 g/kg/h). By analogy to average beta 60 values and back-conversion factors of nonalcoholics, the limit values for alcoholics were estimated as being between 0.12 g/kg/h (minimum value) and 0.29 g/kg/h (maximum value).

Adult↗

[Sudden death in Sanarelli-Shwartzman phenomenon with an unusual pathogen].

The classical generalized Sanarelli-Shwartzman phenomenon (SSP) in animal experiments is induced by two conservative endotoxin injections. The experimental animals mostly die within 24 hours in irreversible shock. They show numerous microthrombi with as high fibrin content in the peripheral vessels of many organs (especially the kidneys) in the context of a consumption coagulopathy. In a 49-year-old man who died within one day of a condition associated with high fever, the clinical picture could be defined on the basis of the clinical and morphological findings as a human equivalent of SSP. The detection of a gram-positive bacterium (Diplococcus pneumoniae), which has been described as the causative organism of SSP only in a few exceptional cases, was noteworthy. The special features of the pathophysiology are described.

Death, Sudden↗

[Epidemiologic studies of the effect of alcohol and drugs on psychophysical performance].

In this new epidemiological investigation, it is first of all observed that the proportion of chemical toxicological investigations instituted by the police in the area served by the Institute of Forensic Medicine, University of Tübingen, has not risen despite increases in the use or abuse of drugs and alcohol consumption although 80 per cent of those concerned are car and motorcycle drivers. On the other hand, is has been noticed in recent years that such investigations are instituted especially when the level of blood alcohol measured does not explain the actual condition of the person concerned. Just under 20 per cent of the affected persons denied consumption of a drug, and more than half admitted the use of a drug. Just under one fifth admitted using two drugs. The remainder used three and four agents. In about half of all cases, the statements were confirmed by the result of the chemical toxicological investigations. In contrast to an investigations of our own, the confirmation of the admissions does not correlate with the rising blood alcohol content. About 63 per cent of the 676 cases investigated had taken analgesics, beta blockers or calcium antagonists, hypnotics or sedatives, gastrointestinal agents and psychoactive agents. The percentage of active agents from the benzodiazepine group, which is subject to the Narcotics Law, is especially great. Finally, the blood and urinary levels of benzodiazepines and individual psychoactive agents measured as well as the pertinent blood and urinary alcohol values were compared with the constellations described in the medical examination and the divergences from the data obtained experimentally are discussed.

Adult↗

[Alcoholic fermentation in "Schwabischen Most": ethanol and alcoholic congener alcohols].

The concentrations of ethanol and congener alcohols in "Schwäbischer Most" were determined (1) at various stages throughout the fermentation process in two different types of "Most", and (2) after completed fermentation in eleven different types. The fermentation process was finished after about five weeks with a final ethanol concentration of 35-54 g/l. According to the congener alcohols the different specimens of "Most" could be classified as beverages like wine. However, the concentrations were found to vary so widely that the analysis of the beverage in question is to be recommended whenever an expert opinion is given. Our studies suggest that the alcohol concentrations do not change significantly, when the fermentation process has been finished.

Ethanol↗

[Sudden death of natural internal cause: endocarditis ulceropolyposa].

There is an increasing tendency amongst the general population towards rejection of conventional medical therapeutic measures, particularly certain types of medication such as antibiotics. Alternative modes of treatment, often undertaken independently by the patient, are favoured. Because of this, diseases that have become less frequent have acquired new significance as the cause of sudden unexpected death. This problem is illustrated with the case of a 20-year-old woman who died as a result of inadequate treatment of subacute bacterial endocarditis (endocarditis ulceropolyposa).

Adult↗

[Cough syncope as a cause of traffic accident].

The rare tussive syncope syndrome, which can lead to a road traffic accident, occurs almost solely in the male aged 40 years and over with a pyknic to athletic physique, who suffer from obstructive respiratory tract disease and/or pulmonary emphysema. Frequently there is a correlation between the illness and alcohol and tobacco consumption. Loss of consciousness lasting only a few seconds occurs a few seconds after a coughing attack leaving behind a short loss of memory. Tussive syncope can be a solitary event, but can also occur up to thirty times a day. In foro, characteristically the link between a heavy coughing and loss of consciousness as well as the type of person make diagnosis easier. The suitability of the subject to hold a driving licence should be judged carefully and on individual criteria.

Accidents, Traffic↗

[Sonography for intracorporeal drug smuggling].

To evaluate the place of ultrasonography in the detection of intracorporeal drug packets (body-packs) ten volunteers were examined by ultrasound after having swallowed four body-packs each. Diagnostic criteria had first been established by ultrasound imaging of body-packs in a water bath. The body-packs contained finger-stalls, 1.5-1.8 cm in diameter, filled with hard-pressed glucose. The criterion for identification in the water-bath was shown to be a sickle-shaped echo with a dorsal echo deficit. This sign identified 23 of the 40 body-packs in eight of the ten subjects. Within the first three hours of ingestion 22 body-packs were demonstrated in eight of the subjects; after 17 hours nine body-packs were identified in the stomach of four subjects. In only one subject was it possible to identify (two) body-packs in the region of the small-large intestine. In practice, intracorporeal drug smugglers will almost always have the body-packs in the stomach at the time of likely examination. Extensive ultrasound screening of suspected smugglers is, therefore, recommended.

Crime↗

[Fatalities in drug dependent patients: suicide or accident?].

The investigation is based on the evaluation of 87 fatalities arising from drug addiction in autopsy material at the Institute for Forensic Medicine, Tübingen. When considered individually there were 76 cases of intoxication, 10 deaths due to external forces and one death due to natural internal causes as a result of drug abuse. The investigation was mainly concerned with the differentiation between suicide or accidental death in the intoxication group. Amongst the total of 76 cases we found 12 to be indisputable or probable suicides and 44 to be indisputable or probable accidents. The remaining 20 could not be classified with sufficient certainty. With the exception of the existence of a farewell letter there were no single meaningful differentiation criteria. There are indications which in themselves are not strong pointers but which, when considered together, allow a cautious interpretation. Finally the question is discussed as to how far the character changes typical in drug addiction can be explained by a latent suicidal tendency with quoad vitam fatalistic indifference.

Accidents↗

[Body-packing: detection of incorporated drug packets using ultrasound technics].

According to the Federal Criminal Office the number of undetected cases of intracorporal drug smuggling is startlingly high. To enable the investigating authorities to carry out searches of suspicious persons in the airport, a safe, comparatively cheap and simple procedure is required. Using nine volunteers the detection of swallowed packets is demonstrated by means of ultrasound techniques. The advantages and disadvantages of this method, as well as the value of the radiological pictorial methods (conventional X-rax check, digital radiography, 2-spectrum-radiography and X-ray computer tomography) which we have already tested, are presented.

Adult↗

[Factors influencing ethanol determination in urine using the TDx system].

The quantification of ethanol in urine samples and the susceptibility to trouble by Abbott Radiative Energy Attenuation (REA) was evaluated and compared with results by gas-chromatography (GC) and by ADH-technique. REA technique shows good reproducibility and specificity, but concerning accuracy Abbott's REA gives always lower results comparing those obtained by GC and ADH.

Alcoholic Intoxication↗

Simulation of physiological ureteral peristalsis.

Occlusive ureteral peristalsis is simulated in an enlarged technical model of the ureter with a lobe-shaped lumen. The local pressure pulse is measured with catheters of different caliber and the influence of the catheters size and position on the uromanometrogram (UMG) is examined. The measurements are compared with UMGs at pathologically changed conditions (stagnation, residual urine depot etc.) and suggestions are given concerning size and shape of catheters to be used for urodynamic measurements.

Humans↗

An active artificial ureter with autonomous energy supply.

For long-term ureteral replacement an artificial ureter has to be able to pump against the outflow resistance into the bladder at any physiological flow rate (0.2-2.0 ml/min). This demand is satisfied only by active prostheses. The active prosthesis described in this paper is driven by the intra-abdominal pressure fluctuations caused by the respiratory movements. The comparison of in vitro results with the parameters of physiological peristalsis proves the applicability of the prosthesis at physiological conditions. Compared to active prostheses with foreign energy supply, this concept promises less burden for patients.

Artificial Organs↗

[Fatal child abuse (caused by physical violence) in Germany during 1 January 1985 to 2 October 1990. Results of a multicenter study].

UNLABELLED: No reliable data are available on cases of lethal child abuse (by active force) in the area of Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 58 cases of lethal child abuse. Extrapolated to all institutes of legal medicine, this corresponds to 62 cases in all of West Germany in the period studied. An approximately equal number of unreported cases should be added to this figure. Including unreported cases, at least 20 cases of lethal child abuse occurred per year; thus only one in every two cases ever came to light. Almost two thirds of the victims were younger than one year old. At autopsy 59% exhibited signs of repeated abuse at autopsy. By far the most common cause of death was direct impact from a blunt object, usually to the head. Mostly, the male person to whom the victim relates most closely (father, stepfather, partner of the mother) has killed the child. Twenty-one of the 74 persons charged saw the charges against them dropped or were acquitted due to lack of evidence; 51 received sentences ranging from one year probation to life. In the remaining two cases the outcome of the trial was unknown. Signs of abuse were readily apparent at autopsy in almost all cases. The high number of unreported cases underscores the need to educate medical students and practicing physicians to be on the look-out for signs of abuse and argues for an increase in the rate of autopsy.

Autopsy↗

[Fatal child neglect in West Germany 1 January 1985 to 2 October 1990. Results of a multicenter study].

UNLABELLED: Up to now reliable data were available on cases of lethal child neglect in the area of the Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period from 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 19 cases of lethal child neglect. Extrapolated to all institutes of legal medicine, this corresponds to 20 cases and thus 3.5 cases a year in the whole of West Germany in the period studied. There is to be added a dark-field which cannot be limited more precisely. However, the cases of fatal child neglect might have occurred much more seldom than fatal child abuse caused by use of physical violence. Slightly more than half the victims were younger than 1 year, the oldest one was 7 10/12 years old. Most frequently the children died of starvation and thirst. Mostly the mothers/nursing mothers killed the child alone or together with the victim's father/stepfather. In the majority of the cases there was not a close affection between parents and child. Nearly 30% female/male perpetrators suffered from chronic alcohol abuse. Only 15 (= 56%) of 27 female/male perpetrators were sentenced to imprisonment (period between 7 months on probation and 10 years). Mitigation circumstances existed for nearly half the persons sentenced to imprisonment. It is true that child neglect is a rarer crime, but the experts of legal medicine always have to indicate errors made during the external inspection of the corpse (among others failures to see indications of neglect).

Cause of Death↗

[Determining body height by the femur and femoral fragments].

Using a forensic series of human specimens, the reliability of frequently-cited formulas applied to estimate body height on the basis of the femur was examined with regard to their accuracy. Very few proved reliable enough to render accurate results. In most cases, less than half of the actual body heights were found to have predicted within the single estimation interval. The method to be used for such estimations must therefore be selected with great care. Even with partial femur measures, it is possible to estimate reliably body height. In particular, the circumference of the diaphysis centre correlates well with body height. The regression equations calculated in the present study, however, reveal greater errors in estimates than the formulas worked out using the total femur length.

Adolescent↗